Provider Demographics
NPI:1417554130
Name:GERBERDING, STEPHANIE RENE (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RENE
Last Name:GERBERDING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:RENE
Other - Last Name:BERUBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2650 RIDGE AVE.
Mailing Address - Street 2:DEPT. OF PSYCHIATRY
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-1011
Mailing Address - Country:US
Mailing Address - Phone:847-570-2540
Mailing Address - Fax:847-570-2939
Practice Address - Street 1:2650 RIDGE AVE.
Practice Address - Street 2:DEPT. OF PSYCHIATRY
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-1011
Practice Address - Country:US
Practice Address - Phone:847-570-2540
Practice Address - Fax:847-570-2939
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490181971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical