Provider Demographics
NPI:1629701495
Name:VASSILEFF, SARAH (LCPC, EMDR)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:VASSILEFF
Suffix:
Gender:F
Credentials:LCPC, EMDR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 N LA SALLE DR APT 523
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-3970
Mailing Address - Country:US
Mailing Address - Phone:224-475-3490
Mailing Address - Fax:
Practice Address - Street 1:1700 W IRVING PARK RD STE AND302
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2559
Practice Address - Country:US
Practice Address - Phone:773-340-1361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.016095101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional