Healthcare Provider Details

I. General information

NPI: 1992814792
Provider Name (Legal Business Name): THOMAS JAMES HERMES LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 IL ROUTE 2
DIXON IL
61021-9118
US

IV. Provider business mailing address

519 E 2ND ST
DIXON IL
61021-3101
US

V. Phone/Fax

Practice location:
  • Phone: 815-284-6611
  • Fax: 815-284-2834
Mailing address:
  • Phone: 815-284-6611
  • Fax: 815-284-2834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.004524
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: