Provider Demographics
NPI:1003900770
Name:GUARISE, SANDRA V (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:V
Last Name:GUARISE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SANDY
Other - Middle Name:
Other - Last Name:GUARISE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1321 W. BIRCHWOOD AV
Mailing Address - Street 2:APT 106
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-1841
Mailing Address - Country:US
Mailing Address - Phone:773-973-0363
Mailing Address - Fax:
Practice Address - Street 1:1440 RENAISSANCE DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068
Practice Address - Country:US
Practice Address - Phone:773-307-0363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical