Provider Demographics
NPI:1215693254
Name:BARRIENTOS, SARA NICHOLE (LCSW)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:NICHOLE
Last Name:BARRIENTOS
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 1:12101 POKEBERRY RD
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62681-4778
Mailing Address - Country:US
Mailing Address - Phone:217-248-3077
Mailing Address - Fax:
Practice Address - Street 1:12101 POKEBERRY RD
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62681-4778
Practice Address - Country:US
Practice Address - Phone:217-248-3077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490183181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical