MEDICARE: SARAH H HARDING MA 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
1	1041C0700X	Clinical Social Worker	149001241	IL

General Provider Information

NPI Number	:	1265415657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH H HARDING MA LCSW

Provider Business Mailing Address
First Line	:	4106 N ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-1805
Country	:	US
Telephone Number	:	773-528-4798
Fax Number	:

Provider Business Practice Location Address
First Line	:	561 W DIVERSEY PARKWAY
Second Line	:	STE # 216
City	:	CHICAGO
State	:	IL
Zip	:	60614-1682
Country	:	US
Telephone Number	:	773-935-1171
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	11/16/2016

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