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General NPI Number Information
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NPI Number | 1083357685
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Entity Type | Individual
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Provider Name | CAMISHA MARTIN
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Gender | Female
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Dates
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Enumeration Date | 04/20/2022
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 1401 WESTERN AVE
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City | CHICAGO HEIGHTS
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State | IL
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Zip | 60411-3147
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Country | US
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Telephone | 708-292-7000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 746715
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City | ATLANTA
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State | GA
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Zip | 30374-6715
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Country | US
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Telephone | 773-352-1515
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Fax | 312-929-0373
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150106147
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.027796
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License Number State | IL
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