Provider Demographics
NPI:1346233665
Name:LETTIERI-MARKS, DONNA (PSYD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:
Last Name:LETTIERI-MARKS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 S MAIN ST
Mailing Address - Street 2:SUITE 371
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5372
Mailing Address - Country:US
Mailing Address - Phone:630-904-6610
Mailing Address - Fax:630-544-3429
Practice Address - Street 1:55 S MAIN ST
Practice Address - Street 2:SUITE 371
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5372
Practice Address - Country:US
Practice Address - Phone:630-904-6610
Practice Address - Fax:630-544-3429
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
50521OtherNATIONAL REGISTER
IL357981Medicare ID - Type Unspecified