Provider Demographics
NPI:1760515654
Name:MARTIN, HARVEY STELL III (PHD)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:STELL
Last Name:MARTIN
Suffix:III
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 1:20635 ABBEY WOODS CT N STE 209
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-3188
Mailing Address - Country:US
Mailing Address - Phone:815-464-8577
Mailing Address - Fax:815-464-8587
Practice Address - Street 1:20635 ABBEY WOODS CT N STE 209
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-3188
Practice Address - Country:US
Practice Address - Phone:815-464-8577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-006721103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209829Medicare ID - Type Unspecified