Provider Demographics
NPI:1740065176
Name:KERGER, MATHIAS RANDOLPH (LCPC; CADC, CRSS)
Entity type:Individual
Prefix:
First Name:MATHIAS
Middle Name:RANDOLPH
Last Name:KERGER
Suffix:
Gender:M
Credentials:LCPC; CADC, CRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 W IRVING PARK RD APT 2506
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3113
Mailing Address - Country:US
Mailing Address - Phone:773-617-6217
Mailing Address - Fax:
Practice Address - Street 1:655 W IRVING PARK RD APT 2506
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3113
Practice Address - Country:US
Practice Address - Phone:773-617-6217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL18003548101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional