Provider Demographics
NPI:1902939085
Name:MATARIEH, SANA A (LCPC)
Entity Type:Individual
Prefix:
First Name:SANA
Middle Name:A
Last Name:MATARIEH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:SUNA
Other - Middle Name:A
Other - Last Name:MATARIEH-HASSAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7059 W 111TH ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:WORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60482-1826
Mailing Address - Country:US
Mailing Address - Phone:708-557-1112
Mailing Address - Fax:708-221-6430
Practice Address - Street 1:7059 W 111TH ST UNIT B
Practice Address - Street 2:
Practice Address - City:WORTH
Practice Address - State:IL
Practice Address - Zip Code:60482-1826
Practice Address - Country:US
Practice Address - Phone:708-604-1112
Practice Address - Fax:708-221-6430
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006236101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01636517Medicare UPIN