Provider Demographics
NPI:1255455382
Name:KUSHNIR, SARA DEBRA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:DEBRA
Last Name:KUSHNIR
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 1:19 FORESTWAY DR
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4805
Mailing Address - Country:US
Mailing Address - Phone:847-267-1234
Mailing Address - Fax:847-267-1236
Practice Address - Street 1:1181 LAKE COOK RD STE A
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5201
Practice Address - Country:US
Practice Address - Phone:847-964-2003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical