Provider Demographics
NPI:1770260986
Name:GROSSMAN, SARA
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:GROSSMAN
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 1:1770 W BERTEAU AVE STE 302A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1750
Mailing Address - Country:US
Mailing Address - Phone:773-234-3044
Mailing Address - Fax:
Practice Address - Street 1:1770 W BERTEAU AVE STE 302A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1750
Practice Address - Country:US
Practice Address - Phone:773-234-3044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist