Provider Demographics
NPI:1003454331
Name:HUSSAIN, SANIA FATIMA (LMHC)
Entity Type:Individual
Prefix:
First Name:SANIA
Middle Name:FATIMA
Last Name:HUSSAIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 W LELAND AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3125
Mailing Address - Country:US
Mailing Address - Phone:312-539-2606
Mailing Address - Fax:
Practice Address - Street 1:303 5TH AVE RM 1707
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6641
Practice Address - Country:US
Practice Address - Phone:312-539-2606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.015505101YP2500X
NY013336101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional