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NPI Code Detail

MEDICARE: MS. SARAH ANN MANAHER LCSW

MEDICARE: MS. SARAH ANN MANAHER LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker149.013890IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
136-4210389OTHERILWOMENCARE COUNSELING CENTER

General Provider Information

NPI Number : 1154551869
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SARAH ANN MANAHER LCSW
Provider Business Mailing Address
First Line : 1029 E 130TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60628-6908
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1029 E 130TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60628-6908
Country : US
Telephone Number : 305-747-2932
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2009
Last Update Date : 08/08/2013

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