Healthcare Provider Details

I. General information

NPI: 1891410023
Provider Name (Legal Business Name): MARTHA WEIL MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 S MILWAUKEE AVE STE 307
LIBERTYVILLE IL
60048-3773
US

IV. Provider business mailing address

303 JOHNSON AVE
LIBERTYVILLE IL
60048-1835
US

V. Phone/Fax

Practice location:
  • Phone: 847-557-0645
  • Fax:
Mailing address:
  • Phone: 224-374-2690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number178.017412
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: