Provider Demographics
NPI:1346836509
Name:VARAN, ANASTAZJA
Entity Type:Individual
Prefix:
First Name:ANASTAZJA
Middle Name:
Last Name:VARAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 E OLD WILLOW RD APT 210
Mailing Address - Street 2:
Mailing Address - City:PROSPECT HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60070-2104
Mailing Address - Country:US
Mailing Address - Phone:773-366-1533
Mailing Address - Fax:
Practice Address - Street 1:810 E OLD WILLOW RD APT 210
Practice Address - Street 2:
Practice Address - City:PROSPECT HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60070-2104
Practice Address - Country:US
Practice Address - Phone:773-366-1533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor