Provider Demographics
NPI:1497721807
Name:BERKHEIMER, KELLY (PSYD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:BERKHEIMER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 W DEMING PL
Mailing Address - Street 2:SUITE 500
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1881
Mailing Address - Country:US
Mailing Address - Phone:773-388-6390
Mailing Address - Fax:773-477-9712
Practice Address - Street 1:467 W DEMING PL
Practice Address - Street 2:SUITE 500
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1881
Practice Address - Country:US
Practice Address - Phone:773-388-6390
Practice Address - Fax:773-477-9712
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71-006768103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK12974Medicare PIN
ILK12974Medicare UPIN