Provider Demographics
NPI:1922558972
Name:MARTIN, PATRICIA L (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:L
Other - Last Name:MCINTIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:27W130 ROOSEVELT RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1611
Mailing Address - Country:US
Mailing Address - Phone:630-588-8490
Mailing Address - Fax:630-588-8491
Practice Address - Street 1:27W130 ROOSEVELT RD
Practice Address - Street 2:SUITE 203
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1611
Practice Address - Country:US
Practice Address - Phone:630-588-8490
Practice Address - Fax:630-588-8491
Is Sole Proprietor?:No
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490146711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical