Basic Information
| Provider Information | |||||||||
| NPI: | 1760981567 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERCU | ||||||||
| FirstName: | TANYA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1230 N HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605061401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129664300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4031 W DAYTON ST | ||||||||
| Address2: | |||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600508377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153441230 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2018 | ||||||||
| LastUpdateDate: | 10/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.