Provider Demographics
NPI:1336432293
Name:MARTIN, MATTHEW (PHD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WACKER DRIVE
Mailing Address - Street 2:1442
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606
Mailing Address - Country:US
Mailing Address - Phone:312-488-9023
Mailing Address - Fax:
Practice Address - Street 1:20 WACKER DRIVE
Practice Address - Street 2:1442
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606
Practice Address - Country:US
Practice Address - Phone:312-488-9023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health