Active NPI
Donna Marie Martino, LCPC
- Mental Health Counselor
- Wauconda, IL
National Provider Identifier
1710277561
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 180007776
- Practice address
- 227 N Main St
Wauconda, IL 60084-1756 - Phone
- (847) 567-1337
- NPI assigned
- Apr 13, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 180007776 | IL | Primary |
Addresses
Primary practice location
227 N Main St
Wauconda, IL 60084-1756
Mailing address
580 Westchester PL SW
Ocean Isle Beach, NC 28469-5679
Phone (847) 567-1337
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 3, 2024 through Apr 3, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180007776 | IL | MD | Mental Health Counselor |
| 16538 | NC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1302652800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687996800000",
"number": "1710277561",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "580 WESTCHESTER PL SW",
"city": "OCEAN ISLE BEACH",
"state": "NC",
"postal_code": "284695679",
"telephone_number": "847-567-1337"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "227 N MAIN ST",
"city": "WAUCONDA",
"state": "IL",
"postal_code": "600841756",
"telephone_number": "847-567-1337"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTINO",
"first_name": "DONNA",
"middle_name": "MARIE",
"credential": "LCPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-04-13",
"last_updated": "2023-06-29",
"certification_date": "2023-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IL",
"license": "180007776",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wauconda, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.