Provider Demographics
NPI:1780738344
Name:NISSIM-SABAT, MARILYN (LCSW)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:NISSIM-SABAT
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 1:4747 S DORCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-2022
Mailing Address - Country:US
Mailing Address - Phone:773-457-5270
Mailing Address - Fax:773-373-2663
Practice Address - Street 1:111 N WABASH AVE
Practice Address - Street 2:1904
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1903
Practice Address - Country:US
Practice Address - Phone:773-457-5270
Practice Address - Fax:773-373-2663
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
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