Provider Demographics
NPI:1710277561
Name:MARTINO, DONNA MARIE (LCPC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:MARTINO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 WESTCHESTER PL SW
Mailing Address - Street 2:
Mailing Address - City:OCEAN ISLE BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28469-5679
Mailing Address - Country:US
Mailing Address - Phone:847-567-1337
Mailing Address - Fax:
Practice Address - Street 1:227 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WAUCONDA
Practice Address - State:IL
Practice Address - Zip Code:60084-1756
Practice Address - Country:US
Practice Address - Phone:847-567-1337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007776101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health