Provider Demographics
NPI:1285318675
Name:MARTINEZ, GENESIS (MS)
Entity type:Individual
Prefix:
First Name:GENESIS
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 SANCTUARY CT
Mailing Address - Street 2:
Mailing Address - City:HAINESVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-3862
Mailing Address - Country:US
Mailing Address - Phone:773-499-0288
Mailing Address - Fax:
Practice Address - Street 1:444 N NORTHWEST HWY STE 320
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-3277
Practice Address - Country:US
Practice Address - Phone:847-220-7298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional