Provider Demographics
NPI:1275658742
Name:HASS, VICTORIA YUSIM (PH D)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:YUSIM
Last Name:HASS
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 LAMON AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2018
Mailing Address - Country:US
Mailing Address - Phone:847-251-4277
Mailing Address - Fax:
Practice Address - Street 1:444 SKOKIE BLVD
Practice Address - Street 2:SUITE 360
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-3086
Practice Address - Country:US
Practice Address - Phone:847-251-2091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL399460Medicare ID - Type UnspecifiedPROVIDER NUMBER