Provider Demographics
NPI:1841417367
Name:BERG, RACHEL ORIEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:ORIEL
Last Name:BERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:BARBARA
Other - Middle Name:BERG
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:116 CORNWALL DR
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-1006
Mailing Address - Country:US
Mailing Address - Phone:708-672-9000
Mailing Address - Fax:708-672-9000
Practice Address - Street 1:116 CORNWALL DR
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:IL
Practice Address - Zip Code:60417-1006
Practice Address - Country:US
Practice Address - Phone:708-672-9000
Practice Address - Fax:708-672-9000
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.001556103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical