Provider Demographics
NPI:1952094302
Name:NIEDERBRACH, SARA Y
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:Y
Last Name:NIEDERBRACH
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 1:3168 PREAKNESS DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-8623
Mailing Address - Country:US
Mailing Address - Phone:630-520-2641
Mailing Address - Fax:
Practice Address - Street 1:27475 FERRY RD STE 105
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-3808
Practice Address - Country:US
Practice Address - Phone:630-520-2641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.108386104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty