Provider Demographics
NPI:1659950269
Name:BERMAN, MACKIE ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MACKIE
Middle Name:ANN
Last Name:BERMAN
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 1:452 N ELIZABETH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-6625
Mailing Address - Country:US
Mailing Address - Phone:312-505-1971
Mailing Address - Fax:
Practice Address - Street 1:1569 SHERMAN AVE STE 200
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4486
Practice Address - Country:US
Practice Address - Phone:312-505-1971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0153231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical