Provider Demographics
NPI:1962079616
Name:SHERBIN, LIZA (LSW)
Entity type:Individual
Prefix:
First Name:LIZA
Middle Name:
Last Name:SHERBIN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W SUPERIOR ST APT 1707
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-8820
Mailing Address - Country:US
Mailing Address - Phone:248-320-0102
Mailing Address - Fax:
Practice Address - Street 1:1 W SUPERIOR ST APT 1707
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-8820
Practice Address - Country:US
Practice Address - Phone:248-320-0102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150104801104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker