Provider Demographics
NPI:1619510757
Name:FISHMAN LEWIS, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:FISHMAN LEWIS
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 1:1666 OLD BRIAR RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-4434
Mailing Address - Country:US
Mailing Address - Phone:847-560-4900
Mailing Address - Fax:
Practice Address - Street 1:1666 OLD BRIAR RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-4434
Practice Address - Country:US
Practice Address - Phone:847-560-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1096922101YM0800X
IL180014238101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health