MEDICARE: DR. SARA SIROTA

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	103TC0700X	Clinical Psychologist	071.009394	IL

General Provider Information

NPI Number	:	1497365910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARA SIROTA

Provider Business Mailing Address
First Line	:	5133 N KENMORE AVE # 2N
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-3109
Country	:	US
Telephone Number	:	847-331-1919
Fax Number	:

Provider Business Practice Location Address
First Line	:	5443 N BROADWAY ST # 2S
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-1703
Country	:	US
Telephone Number	:	847-331-1919
Fax Number	:

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

Provider Enumeration Date	:	08/10/2020
Last Update Date	:	08/10/2020

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Directions to “ DR. SARA SIROTA ” Practice Location

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