MEDICARE: MRS. SARA LAHEY PRICE L.C.S.W.

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	149.013442	IL

General Provider Information

NPI Number	:	1306074752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARA LAHEY PRICE L.C.S.W.

Provider Business Mailing Address
First Line	:	4801 BARREVILLE RD
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60012-2151
Country	:	US
Telephone Number	:	815-301-6900
Fax Number	:

Provider Business Practice Location Address
First Line	:	7115 VIRGINIA RD
Second Line	:	STE. 110
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-3112
Country	:	US
Telephone Number	:	815-301-6900
Fax Number	:

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

Provider Enumeration Date	:	06/24/2009
Last Update Date	:	06/24/2009

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