Provider Demographics
NPI:1023212578
Name:BERENBERG, ANNE HATCHER (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:HATCHER
Last Name:BERENBERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 W FRONTAGE RD
Mailing Address - Street 2:SUITE 2135
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-1250
Mailing Address - Country:US
Mailing Address - Phone:847-784-9005
Mailing Address - Fax:
Practice Address - Street 1:540 W FRONTAGE RD
Practice Address - Street 2:SUITE 2135
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-1250
Practice Address - Country:US
Practice Address - Phone:847-784-9005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical