Provider Demographics
NPI:1528218427
Name:MARSHMAN, AMY T (LMSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:T
Last Name:MARSHMAN
Suffix:
Gender:F
Credentials:LMSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 GAME TRL APT 101
Mailing Address - Street 2:
Mailing Address - City:LAKEMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60051-6418
Mailing Address - Country:US
Mailing Address - Phone:773-603-5566
Mailing Address - Fax:
Practice Address - Street 1:831 GAME TRL APT 101
Practice Address - Street 2:
Practice Address - City:LAKEMOOR
Practice Address - State:IL
Practice Address - Zip Code:60051-6418
Practice Address - Country:US
Practice Address - Phone:773-603-5566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490131341041C0700X
WI7416-1231041C0700X
MI68010893001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical