Provider Demographics
NPI:1427353937
Name:SERBIN, SIMONE THERSE (MA)
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:THERSE
Last Name:SERBIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7538 N OTTAWA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-4239
Mailing Address - Country:US
Mailing Address - Phone:773-307-2055
Mailing Address - Fax:773-775-4484
Practice Address - Street 1:7538 N OTTAWA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-4239
Practice Address - Country:US
Practice Address - Phone:773-307-2055
Practice Address - Fax:773-775-4484
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist