Provider Demographics
NPI:1821240136
Name:SHARON BORIS, LCSW LLC
Entity Type:Organization
Organization Name:SHARON BORIS, LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:BORIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:708-217-2726
Mailing Address - Street 1:4326 PRINCE ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-2875
Mailing Address - Country:US
Mailing Address - Phone:708-217-2726
Mailing Address - Fax:
Practice Address - Street 1:4326 PRINCE ST
Practice Address - Street 2:SUITE 4
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-2875
Practice Address - Country:US
Practice Address - Phone:708-217-2726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0074171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty