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NPI Code Detail

MEDICARE: MS. DEVORAH SARAH LMFT

MEDICARE: MS. DEVORAH SARAH LMFT
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
1106H00000XMarriage & Family Therapist166.001647IL

General Provider Information

NPI Number : 1235994989
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DEVORAH SARAH LMFT
Provider Business Mailing Address
First Line : 2543 W CULLOM AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60618-1501
Country : US
Telephone Number : 773-318-3624
Fax Number :
Provider Business Practice Location Address
First Line : 2543 W CULLOM AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60618-1501
Country : US
Telephone Number : 773-318-3624
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2024
Last Update Date : 02/20/2024

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