Provider Demographics
NPI:1255964524
Name:STACI BERMAN, LMFT, PC
Entity type:Organization
Organization Name:STACI BERMAN, LMFT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACI
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-261-0453
Mailing Address - Street 1:180 N MICHIGAN AVE STE 2415
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7481
Mailing Address - Country:US
Mailing Address - Phone:312-261-0453
Mailing Address - Fax:
Practice Address - Street 1:180 N MICHIGAN AVE STE 2415
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7481
Practice Address - Country:US
Practice Address - Phone:312-261-0453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-14
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty