Provider Demographics
NPI:1518937556
Name:FORSYTHE MENNA, SARA SUZANNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:SUZANNE
Last Name:FORSYTHE MENNA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 BEVERLY DR
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-3010
Mailing Address - Country:US
Mailing Address - Phone:312-213-1137
Mailing Address - Fax:
Practice Address - Street 1:5100 N RAVENSWOOD AVE STE 236
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1752
Practice Address - Country:US
Practice Address - Phone:312-337-5874
Practice Address - Fax:312-337-9243
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490072751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical