Provider Demographics
NPI:1255462024
Name:HASSELMAN, MARK (LCSW)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:HASSELMAN
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 1:745 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-2108
Mailing Address - Country:US
Mailing Address - Phone:800-428-7260
Mailing Address - Fax:847-428-7269
Practice Address - Street 1:745 S 8TH ST
Practice Address - Street 2:
Practice Address - City:WEST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-2108
Practice Address - Country:US
Practice Address - Phone:800-428-7260
Practice Address - Fax:847-428-7269
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490063341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL284771Medicare ID - Type Unspecified
IL284772Medicare ID - Type Unspecified
IL284770Medicare ID - Type Unspecified