Provider Demographics
NPI:1407981632
Name:DAMASCO, JEROME (LCSW)
Entity type:Individual
Prefix:MR
First Name:JEROME
Middle Name:
Last Name:DAMASCO
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 1:7707 KENNETH AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-3617
Mailing Address - Country:US
Mailing Address - Phone:312-749-7934
Mailing Address - Fax:847-972-1120
Practice Address - Street 1:1140 LAKE ST
Practice Address - Street 2:SUITE 302
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1049
Practice Address - Country:US
Practice Address - Phone:312-749-7934
Practice Address - Fax:847-972-1120
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
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