Bermak, Jacqueline
Bermak, Jacqueline is an individual health care provider with primary practice located at 2530 Crawford Ave Suite 317, Evanston IL 60201-4970. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Bermak, Jacqueline can be contacted via phone (847) 864-9300.Contact Information
Primary practice address
2530 Crawford Ave Suite 317
Evanston IL 60201-4970
Phone: (847) 864-9300
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | Illinois |
Profile Details
| NPI number | 1891770640 |
|---|---|
| LBN Legal business name | Bermak, Jacqueline |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 14th, 2005 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1891770640 | NPPES |
| Illinois | Other | 1633250 | BLUE SHIELD PROVIDER # |
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