Provider Demographics
NPI:1013436906
Name:MARTINEZ, SERGIO (LSW, CADC)
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 MANCHESTER RD STE 1510
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-4561
Mailing Address - Country:US
Mailing Address - Phone:630-653-1717
Mailing Address - Fax:630-653-9691
Practice Address - Street 1:2100 MANCHESTER RD STE 1510
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-4561
Practice Address - Country:US
Practice Address - Phone:630-653-1717
Practice Address - Fax:630-653-9691
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.102532101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty