MEDICARE: SARAH B. WARREN PHD & ASSOCIATES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QC1500X	Community Health Clinic/Center
2	261QC1800X	Corporate Health Clinic/Center
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center
4	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1790132215
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SARAH B. WARREN PHD & ASSOCIATES PC

Provider Business Mailing Address
First Line	:	480 N MCCLURG CT
Second Line	:	513
City	:	CHICAGO
State	:	IL
Zip	:	60611-4326
Country	:	US
Telephone Number	:	312-595-1691
Fax Number	:

Provider Business Practice Location Address
First Line	:	480 N MCCLURG CT
Second Line	:	513
City	:	CHICAGO
State	:	IL
Zip	:	60611-4326
Country	:	US
Telephone Number	:	312-595-1691
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SARAH WARREN
Credential	:	PHD
Telephone Number	:	312-595-1691

Provider Enumeration Date	:	05/16/2016
Last Update Date	:	05/16/2016

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