Provider Demographics
NPI:1609094044
Name:DAS, SANJNA (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:SANJNA
Middle Name:
Last Name:DAS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 W PETERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-4100
Mailing Address - Country:US
Mailing Address - Phone:773-761-0010
Mailing Address - Fax:773-761-0009
Practice Address - Street 1:2424 W PETERSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-4100
Practice Address - Country:US
Practice Address - Phone:773-761-0010
Practice Address - Fax:773-761-0009
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0038771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149-003877OtherLICENSE