Provider Demographics
NPI:1730816232
Name:MARCUCCILLI, SABRINA (MSW)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:MARCUCCILLI
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1644 W COLONIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:IL
Mailing Address - Zip Code:60067-1207
Mailing Address - Country:US
Mailing Address - Phone:847-776-4500
Mailing Address - Fax:847-776-4724
Practice Address - Street 1:215 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-2570
Practice Address - Country:US
Practice Address - Phone:847-776-4500
Practice Address - Fax:847-776-4724
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150104310104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker