Healthcare Provider Details

I. General information

NPI: 1659777829
Provider Name (Legal Business Name): MARIANA SANCHEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2014
Last Update Date: 11/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 W TOUHY AVE
CHICAGO IL
60645-2833
US

IV. Provider business mailing address

3003 W TOUHY AVE
CHICAGO IL
60645-2833
US

V. Phone/Fax

Practice location:
  • Phone: 773-508-1000
  • Fax: 773-508-1112
Mailing address:
  • Phone: 773-508-1000
  • Fax: 773-508-1112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.017030
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: