Provider Demographics
NPI:1366823585
Name:THOMAS UNDINE
Entity Type:Organization
Organization Name:THOMAS UNDINE
Other - Org Name:UNDINE AND ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDING THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:UNDINE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-732-7700
Mailing Address - Street 1:410 S MICHIGAN AVE STE 943
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-1399
Mailing Address - Country:US
Mailing Address - Phone:773-732-7700
Mailing Address - Fax:773-304-3517
Practice Address - Street 1:410 S MICHIGAN AVE STE 943
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-1399
Practice Address - Country:US
Practice Address - Phone:773-732-7700
Practice Address - Fax:773-304-3517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0130591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty