Provider Demographics
NPI:1285468157
Name:BERRY, NORMAN L
Entity type:Individual
Prefix:
First Name:NORMAN
Middle Name:L
Last Name:BERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2136 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60087-3905
Mailing Address - Country:US
Mailing Address - Phone:224-321-3203
Mailing Address - Fax:
Practice Address - Street 1:500 COVENTRY LN STE 260
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7592
Practice Address - Country:US
Practice Address - Phone:224-321-3203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-31
Last Update Date:2024-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker