Provider Demographics
NPI:1083467922
Name:BERMINGHAM, KRISTINE (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:BERMINGHAM
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25816 S WOODRUSH WAY
Mailing Address - Street 2:
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-8774
Mailing Address - Country:US
Mailing Address - Phone:708-692-5747
Mailing Address - Fax:
Practice Address - Street 1:25224 W EAMES ST STE D
Practice Address - Street 2:
Practice Address - City:CHANNAHON
Practice Address - State:IL
Practice Address - Zip Code:60410-5256
Practice Address - Country:US
Practice Address - Phone:815-467-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150111094104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker