Provider Demographics
NPI:1720779945
Name:SARA B THERAPY FOR WOMEN AND ADOLESCENTS, PLLC
Entity type:Organization
Organization Name:SARA B THERAPY FOR WOMEN AND ADOLESCENTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BRUGIONI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-546-7268
Mailing Address - Street 1:5902 SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60012-1241
Mailing Address - Country:US
Mailing Address - Phone:815-546-7268
Mailing Address - Fax:
Practice Address - Street 1:5902 SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60012-1241
Practice Address - Country:US
Practice Address - Phone:815-546-7268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty