Healthcare Provider Details

I. General information

NPI: 1174416366
Provider Name (Legal Business Name): JOSEPH MARTIN BASSO III LCSW, CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W JACKSON BLVD STE 1700
CHICAGO IL
60604-3597
US

IV. Provider business mailing address

111 W JACKSON BLVD STE 1700
CHICAGO IL
60604-3597
US

V. Phone/Fax

Practice location:
  • Phone: 646-941-7645
  • Fax: 929-596-7897
Mailing address:
  • Phone: 646-941-7645
  • Fax: 929-596-7897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.029052
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: