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Organization
SACRED SPACES, INC
Active
Organization
SACRED SPACES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARIA A CARUSO MSW, LCSW (PRESIDENT)
(847) 947-7646
Entity
Organization
Contact information
Practice address
380 W PALATINE RD, SUITE 6, WHEELING, IL 60090-5831
(847) 947-7646
(847) 947-7645
Mailing address
380 W PALATINE RD, SUITE 6, WHEELING, IL 60090-5831
(847) 947-7646
(847) 947-7645
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4932184
BCBSIL PIN
IL
Enumeration date
04/05/2006
Last updated
08/22/2020
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