MEDICARE: MR. THOMAS HERMAN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	150015570	IL
2	1041C0700X	Clinical Social Worker	149-019294	IL

General Provider Information

NPI Number	:	1225424260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS HERMAN LCSW

Provider Business Mailing Address
First Line	:	4541 N HAMILTON APT. 3E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625
Country	:	US
Telephone Number	:	773-517-5505
Fax Number	:

Provider Business Practice Location Address
First Line	:	5412 N CLARK ST STE 226
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-1223
Country	:	US
Telephone Number	:	773-517-5505
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2015
Last Update Date	:	07/21/2022

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