Provider Demographics
NPI:1972972891
Name:CENTER FOR EMOTIONAL WELLNESS OF THE NORTHWEST SUBURBS
Entity type:Organization
Organization Name:CENTER FOR EMOTIONAL WELLNESS OF THE NORTHWEST SUBURBS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-342-9786
Mailing Address - Street 1:4010 HILLCREST PL
Mailing Address - Street 2:
Mailing Address - City:JOHNSBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60051-5928
Mailing Address - Country:US
Mailing Address - Phone:815-342-9786
Mailing Address - Fax:
Practice Address - Street 1:4010 HILLCREST PL
Practice Address - Street 2:
Practice Address - City:JOHNSBURG
Practice Address - State:IL
Practice Address - Zip Code:60051-5928
Practice Address - Country:US
Practice Address - Phone:815-342-9786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-21
Last Update Date:2015-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009906101YP2500X
IL149.0154821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty