Provider Demographics
NPI:1417017153
Name:SWEIS, BASMAN (PSY D)
Entity Type:Individual
Prefix:DR
First Name:BASMAN
Middle Name:
Last Name:SWEIS
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6502 JOLIET RD FL 2
Mailing Address - Street 2:
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-4613
Mailing Address - Country:US
Mailing Address - Phone:708-215-8400
Mailing Address - Fax:708-215-8410
Practice Address - Street 1:6502 JOLIET RD FL 2
Practice Address - Street 2:
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525
Practice Address - Country:US
Practice Address - Phone:708-215-8400
Practice Address - Fax:708-215-8410
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-004208103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL071-004208OtherSTATE LICENSE NUMBER