Basic Information
| Provider Information | |||||||||
| NPI: | 1497721807 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERKHEIMER | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | |||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 467 W DEMING PL | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606141881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7733886390 | ||||||||
| FaxNumber: | 7734779712 | ||||||||
| Practice Location | |||||||||
| Address1: | 467 W DEMING PL | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606141881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7733886390 | ||||||||
| FaxNumber: | 7734779712 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2006 | ||||||||
| LastUpdateDate: | 03/12/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 71-006768 | IL | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.