Provider Demographics
NPI:1215045331
Name:BERLER, MELISSA R (LCSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:R
Last Name:BERLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 ASBURY AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4101
Mailing Address - Country:US
Mailing Address - Phone:847-533-7686
Mailing Address - Fax:
Practice Address - Street 1:1633 ASBURY AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4101
Practice Address - Country:US
Practice Address - Phone:847-533-7686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490064711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01622905OtherBCBS
IL207253Medicare ID - Type Unspecified