Provider Demographics
NPI:1063650141
Name:LEMON, MARTIN EDWARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:EDWARD
Last Name:LEMON
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 1:28379 DAVIS PKWY
Mailing Address - Street 2:SUITE 801
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-3032
Mailing Address - Country:US
Mailing Address - Phone:630-393-9800
Mailing Address - Fax:639-393-0499
Practice Address - Street 1:28379 DAVIS PKWY
Practice Address - Street 2:SUITE 801
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-3032
Practice Address - Country:US
Practice Address - Phone:630-393-9800
Practice Address - Fax:639-393-0499
Is Sole Proprietor?:No
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004794103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical