Provider Demographics
NPI:1972537157
Name:SHAKHMAN, MARINA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARINA
Middle Name:
Last Name:SHAKHMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:MARINA
Other - Middle Name:
Other - Last Name:KSENDZOVSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1800 HOLLISTER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5266
Mailing Address - Country:US
Mailing Address - Phone:847-549-1189
Mailing Address - Fax:
Practice Address - Street 1:1800 HOLLISTER DR STE 201
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5266
Practice Address - Country:US
Practice Address - Phone:847-549-1189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006732103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical