Provider Demographics
NPI:1457628836
Name:EDUMEDIA INC.
Entity Type:Organization
Organization Name:EDUMEDIA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MC CARTHY, JR.
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-475-1988
Mailing Address - Street 1:129 WELWYN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-1151
Mailing Address - Country:US
Mailing Address - Phone:847-604-4040
Mailing Address - Fax:
Practice Address - Street 1:129 WELWYN ST
Practice Address - Street 2:
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-1151
Practice Address - Country:US
Practice Address - Phone:847-604-4040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.003813103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL42143001Medicare PIN