Provider Demographics
NPI:1467281220
Name:BASARIA, SABRINA ROSE-MARY (LPC)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:ROSE-MARY
Last Name:BASARIA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6007 N SHERIDAN RD APT 21C
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-3005
Mailing Address - Country:US
Mailing Address - Phone:630-550-9576
Mailing Address - Fax:
Practice Address - Street 1:4028 W IRVING PARK RD # LOFTB
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2925
Practice Address - Country:US
Practice Address - Phone:773-850-9046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.020420101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional