Individual
DANIEL MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LSW
Contact information
Practice address
3010 GRAND AVE, WAUKEGAN, IL 60085-2321
(847) 377-8077
(847) 984-5682
Mailing address
3010 GRAND AVE, WAUKEGAN, IL 60085-2321
(847) 377-8077
(847) 984-5682
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149005797
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
150004223
—
IL
Enumeration date
07/27/2006
Last updated
08/28/2012
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