MEDICARE: MR. THOMAS JAMES HERMES 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	1041C0700X	Clinical Social Worker	149.004524	IL

General Provider Information

NPI Number	:	1992814792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS JAMES HERMES LCSW

Provider Business Mailing Address
First Line	:	519 E 2ND ST
Second Line	:
City	:	DIXON
State	:	IL
Zip	:	61021-3101
Country	:	US
Telephone Number	:	815-284-6611
Fax Number	:	815-284-2834

Provider Business Practice Location Address
First Line	:	325 IL ROUTE 2
Second Line	:
City	:	DIXON
State	:	IL
Zip	:	61021-9118
Country	:	US
Telephone Number	:	815-284-6611
Fax Number	:	815-284-2834

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	07/08/2007

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