Provider Demographics
NPI:1992934566
Name:BERCOS, ANDREA
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:BERCOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 N KENNICOTT AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-7813
Mailing Address - Country:US
Mailing Address - Phone:847-710-0089
Mailing Address - Fax:847-398-7808
Practice Address - Street 1:3411 N KENNICOTT AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-7813
Practice Address - Country:US
Practice Address - Phone:847-710-0089
Practice Address - Fax:847-398-7808
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-05
Last Update Date:2009-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490124571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical