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General NPI Number Information
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NPI Number | 1639443138
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Entity Type | Individual
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Provider Name | DAMASO ALLEN HODGES LCSW
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Gender | Male
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Dates
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Enumeration Date | 03/01/2012
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Last Update Date | 11/20/2019
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Provider Practice Location Address
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Address Line | 1639 W FOSTER AVE APT 2
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City | CHICAGO
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State | IL
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Zip | 60640-2086
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Country | US
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Telephone | 330-280-3032
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Fax |
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Provider Business Mailing Address
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Address Line | 1996 APACHE TRL
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City | ROUND LAKE BEACH
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State | IL
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Zip | 60073-1365
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Country | US
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Telephone | 330-280-3032
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149021755
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150101823
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License Number State | IL
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