Provider Demographics
NPI:1316965486
Name:BERNT, CONSTANCE LYNN (PSYD)
Entity type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:LYNN
Last Name:BERNT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 S PLYMOUTH CT APT 806
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2046
Mailing Address - Country:US
Mailing Address - Phone:312-913-3408
Mailing Address - Fax:
Practice Address - Street 1:1010 LAKE ST STE 426
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1185
Practice Address - Country:US
Practice Address - Phone:708-848-9959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL320400Medicare ID - Type UnspecifiedMENTAL HEALTH PROVIDER