Provider Demographics
NPI:1033324074
Name:PARKER, MARTIN M (PSYD CADC MISA II)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:M
Last Name:PARKER
Suffix:
Gender:M
Credentials:PSYD CADC MISA II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 PINEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:IL
Mailing Address - Zip Code:60022-1033
Mailing Address - Country:US
Mailing Address - Phone:847-446-7755
Mailing Address - Fax:
Practice Address - Street 1:1780 MAPLE ST
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3021
Practice Address - Country:US
Practice Address - Phone:847-446-7755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL#1186101YA0400X
MN#1459103TA0400X
CA#11830103TC0700X
IL071.007725103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)