Provider Demographics
NPI:1790839116
Name:HERATY, JOHN THOMAS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:THOMAS
Last Name:HERATY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 N MORRIS DR
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-5646
Mailing Address - Country:US
Mailing Address - Phone:847-508-3638
Mailing Address - Fax:
Practice Address - Street 1:5301 DEMPSTER ST
Practice Address - Street 2:SUITE 205
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1846
Practice Address - Country:US
Practice Address - Phone:847-508-3638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
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