MEDICARE: HARVEY MARTIN & ASSOCIATES INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	071006721	IL

General Provider Information

NPI Number	:	1912030735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARVEY MARTIN & ASSOCIATES INC.

Provider Business Mailing Address
First Line	:	2130 CEDAR RD
Second Line	:
City	:	HOMEWOOD
State	:	IL
Zip	:	60430-1204
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10217 W LINCOLN HWY
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-1279
Country	:	US
Telephone Number	:	708-960-0804
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. HARVEY MARTIN III
Credential	:	PH.D.
Telephone Number	:	708-960-0804

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	12/10/2009

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