| Martin Srajek Phd Lcsw Ltd | |
|
206 N Randolph St Ste 534-36 Champaign IL 61820-3949 | |
| (217) 637-2138 | |
| (217) 355-4911 |
| Full Name | Martin Srajek Phd Lcsw Ltd |
|---|---|
| Speciality | Clinic/Center |
| Location | 206 N Randolph St Ste 534-36, Champaign, Illinois |
| Authorized Official Name and Position | Martin Srajek (DIRECTOR) |
| Authorized Official Contact | 2176372138 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Martin Srajek Phd Lcsw Ltd 206 N Randolph St Ste 534-36 Champaign IL 61820-3949 Ph: (217) 637-2138 | Martin Srajek Phd Lcsw Ltd 206 N Randolph St Ste 534-36 Champaign IL 61820-3949 Ph: (217) 637-2138 |
| NPI Number | 1154955037 |
|---|---|
| Provider Enumeration Date | 02/28/2020 |
| Last Update Date | 06/24/2025 |
| Certification Date | 06/24/2025 |
| Medicare PECOS PAC ID | 0143650333 |
|---|---|
| Medicare Enrollment ID | O20200501001170 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154955037 | NPI | - | NPPES |
| S622-5686-1037 | Other | IL | DRIVERS LICENSE |
| 1730392481 | Other | IL | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Martin Srajek |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730392481 PECOS PAC ID: 3779650155 Enrollment ID: I20080926000383 |
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