Provider Demographics
NPI:1265904858
Name:BERTRAM, ANTHONY (LCSW CADC CODP)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:BERTRAM
Suffix:
Gender:M
Credentials:LCSW CADC CODP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1590 S MILWAUKEE AVE STE 224
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3785
Mailing Address - Country:US
Mailing Address - Phone:847-873-9594
Mailing Address - Fax:
Practice Address - Street 1:1590 S MILWAUKEE AVE STE 224
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3785
Practice Address - Country:US
Practice Address - Phone:847-873-9594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-20
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0185511041C0700X
IL1490185511041C0700X
1490185511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical