MEDICARE: SARAH VASSILEFF LCPC, EMDR

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	101YP2500X	Professional Counselor	180.016095	IL

General Provider Information

NPI Number	:	1629701495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH VASSILEFF LCPC, EMDR

Provider Business Mailing Address
First Line	:	676 N LA SALLE DR APT 523
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-3970
Country	:	US
Telephone Number	:	224-475-3490
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 W IRVING PARK RD STE AND302
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-2559
Country	:	US
Telephone Number	:	773-340-1361
Fax Number	:

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

Provider Enumeration Date	:	07/07/2022
Last Update Date	:	06/12/2024

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