Provider Demographics
NPI:1114373628
Name:MARENA SABO, LCSW, PC
Entity Type:Organization
Organization Name:MARENA SABO, LCSW, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARENA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SABO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-341-4263
Mailing Address - Street 1:4636 N RAVENSWOOD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-4581
Mailing Address - Country:US
Mailing Address - Phone:773-341-4263
Mailing Address - Fax:773-360-8814
Practice Address - Street 1:4636 N RAVENSWOOD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-4581
Practice Address - Country:US
Practice Address - Phone:773-341-4263
Practice Address - Fax:773-360-8814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490083791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty