Provider Demographics
NPI:1447354550
Name:BERRES, MARY KAY C (LPCP)
Entity type:Individual
Prefix:MRS
First Name:MARY KAY
Middle Name:C
Last Name:BERRES
Suffix:
Gender:F
Credentials:LPCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2603 S WASHINGTON ST
Mailing Address - Street 2:STE 140
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565
Mailing Address - Country:US
Mailing Address - Phone:630-420-3944
Mailing Address - Fax:630-499-0345
Practice Address - Street 1:2603 S WASHINGTON ST
Practice Address - Street 2:STE 140
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565
Practice Address - Country:US
Practice Address - Phone:630-420-3944
Practice Address - Fax:630-499-0345
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy