Healthcare Provider Details

I. General information

NPI: 1003386277
Provider Name (Legal Business Name): MICHAEL SARACENO LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 ROHLWING RD
ELK GROVE VILLAGE IL
60007-3217
US

IV. Provider business mailing address

1516 CONCORD AVE
WESTCHESTER IL
60154-3536
US

V. Phone/Fax

Practice location:
  • Phone: 847-524-8800
  • Fax:
Mailing address:
  • Phone: 708-269-8341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178014195
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: