Provider Demographics
NPI:1659768083
Name:LISA M. BERG, LCSW AND ASSOCIATES, LLC
Entity Type:Organization
Organization Name:LISA M. BERG, LCSW AND ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:224-788-8156
Mailing Address - Street 1:869 MOCKING BIRD DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-2726
Mailing Address - Country:US
Mailing Address - Phone:224-788-8156
Mailing Address - Fax:
Practice Address - Street 1:532 LAKE ST
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-1424
Practice Address - Country:US
Practice Address - Phone:224-357-6793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490071421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty