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General NPI Number Information
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NPI Number | 1912030735
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Entity Type | Organization
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Legal Business Name | HARVEY MARTIN & ASSOCIATES INC.
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 12/10/2009
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Provider Practice Location Address
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Address Line | 10217 W LINCOLN HWY
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City | FRANKFORT
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State | IL
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Zip | 60423-1279
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Country | US
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Telephone | 708-960-0804
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Fax |
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Provider Business Mailing Address
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Address Line | 2130 CEDAR RD
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City | HOMEWOOD
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State | IL
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Zip | 60430-1204
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. HARVEY MARTIN III
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Credential | PH.D.
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Telephone | 708-960-0804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071006721
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License Number State | IL
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