Provider Demographics
NPI:1801637020
Name:MARTIN, DAPHNE JANICE
Entity type:Individual
Prefix:MISS
First Name:DAPHNE
Middle Name:JANICE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 GOLF RD APT 202
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-4746
Mailing Address - Country:US
Mailing Address - Phone:773-226-6562
Mailing Address - Fax:
Practice Address - Street 1:4848 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2718
Practice Address - Country:US
Practice Address - Phone:773-347-9002
Practice Address - Fax:773-866-8015
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0270641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical