Provider Demographics
NPI:1841596475
Name:MARDER, MATTHEW JAY (LCSW)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JAY
Last Name:MARDER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 FAULKNER PL
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1418
Mailing Address - Country:US
Mailing Address - Phone:847-420-5103
Mailing Address - Fax:
Practice Address - Street 1:821 FAULKNER PL
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1418
Practice Address - Country:US
Practice Address - Phone:847-420-5103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-29
Last Update Date:2011-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0138481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical