Provider Demographics
NPI:1790132215
Name:SARAH B. WARREN PHD & ASSOCIATES PC
Entity Type:Organization
Organization Name:SARAH B. WARREN PHD & ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-595-1691
Mailing Address - Street 1:480 N MCCLURG CT
Mailing Address - Street 2:513
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4326
Mailing Address - Country:US
Mailing Address - Phone:312-595-1691
Mailing Address - Fax:
Practice Address - Street 1:480 N MCCLURG CT
Practice Address - Street 2:513
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4326
Practice Address - Country:US
Practice Address - Phone:312-595-1691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health