Provider Demographics
NPI:1407342223
Name:SAINT GEORGE, CLARIZA (LSW, CADC)
Entity Type:Individual
Prefix:MS
First Name:CLARIZA
Middle Name:
Last Name:SAINT GEORGE
Suffix:
Gender:F
Credentials:LSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 66019
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60666-0019
Mailing Address - Country:US
Mailing Address - Phone:773-894-2427
Mailing Address - Fax:773-686-7564
Practice Address - Street 1:10000 W O'HARE AVE
Practice Address - Street 2:TERMINAL 2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60666-0019
Practice Address - Country:US
Practice Address - Phone:773-894-2427
Practice Address - Fax:773-686-7564
Is Sole Proprietor?:No
Enumeration Date:2018-07-04
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL34682101YA0400X
IL150.103203104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)