Provider Demographics
NPI:1891410023
Name:WEIL, MARTHA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:WEIL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-1835
Mailing Address - Country:US
Mailing Address - Phone:224-374-2690
Mailing Address - Fax:
Practice Address - Street 1:1580 S MILWAUKEE AVE STE 307
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3773
Practice Address - Country:US
Practice Address - Phone:847-557-0645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.017412101Y00000X
221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist