Healthcare Provider Details

I. General information

NPI: 1265415657
Provider Name (Legal Business Name): SARAH H HARDING MA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 W DIVERSEY PARKWAY STE # 216
CHICAGO IL
60614-1682
US

IV. Provider business mailing address

4106 N ASHLAND AVE
CHICAGO IL
60613-1805
US

V. Phone/Fax

Practice location:
  • Phone: 773-935-1171
  • Fax:
Mailing address:
  • Phone: 773-528-4798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149001241
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: