Provider Demographics
NPI:1063583532
Name:SCRIPP, MARTIN W (PHD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:W
Last Name:SCRIPP
Suffix:
Gender:M
Credentials:PHD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1701 E WOODFIELD RD
Mailing Address - Street 2:SUITE 321
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-5905
Mailing Address - Country:US
Mailing Address - Phone:847-413-8940
Mailing Address - Fax:847-413-0429
Practice Address - Street 1:1701 E WOODFIELD RD
Practice Address - Street 2:SUITE 321
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5905
Practice Address - Country:US
Practice Address - Phone:847-413-8940
Practice Address - Fax:847-413-0429
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL712556103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical