Provider Demographics
NPI:1487025862
Name:BERGE, AMANDA (LCPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BERGE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:J
Other - Last Name:BERGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC
Mailing Address - Street 1:135 PARK AVE
Mailing Address - Street 2:LL4
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-4370
Mailing Address - Country:US
Mailing Address - Phone:224-633-3319
Mailing Address - Fax:
Practice Address - Street 1:135 PARK AVE
Practice Address - Street 2:LL4
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-4370
Practice Address - Country:US
Practice Address - Phone:224-633-3319
Practice Address - Fax:847-713-3993
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178009847101YP2500X
IL180009982101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional