Provider Demographics
NPI:1811435027
Name:ANTHONY, JERMAINE SR (LCSW,CRADC, DOT-SAP)
Entity type:Individual
Prefix:MR
First Name:JERMAINE
Middle Name:
Last Name:ANTHONY
Suffix:SR
Gender:M
Credentials:LCSW,CRADC, DOT-SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2964
Mailing Address - Street 2:
Mailing Address - City:EAST CHICAGO
Mailing Address - State:IN
Mailing Address - Zip Code:46312-7964
Mailing Address - Country:US
Mailing Address - Phone:630-677-0450
Mailing Address - Fax:314-431-6420
Practice Address - Street 1:8892 LOUISANA STREET, SUITE D-2
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-4641
Practice Address - Country:US
Practice Address - Phone:630-677-0450
Practice Address - Fax:314-431-6420
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-08
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL31221101YA0400X
IL149.0286471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)