Provider Demographics
NPI:1093726358
Name:BERNSTEIN, ALICE MADELINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:MADELINE
Last Name:BERNSTEIN
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 1:1420 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2546
Mailing Address - Country:US
Mailing Address - Phone:312-498-9205
Mailing Address - Fax:847-256-0532
Practice Address - Street 1:300 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-5101
Practice Address - Country:US
Practice Address - Phone:312-357-0022
Practice Address - Fax:847-256-0532
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILR17719Medicare UPIN
IL750480Medicare ID - Type Unspecified