Provider Demographics
NPI:1699850859
Name:BASS, THOMAS (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:BASS
Suffix:
Gender:M
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:992 1/2 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-1722
Mailing Address - Country:US
Mailing Address - Phone:847-446-8060
Mailing Address - Fax:847-446-9768
Practice Address - Street 1:992 1/2 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-1722
Practice Address - Country:US
Practice Address - Phone:847-446-8060
Practice Address - Fax:847-446-9768
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical