Provider Demographics
NPI:1699149252
Name:MARTINEZ, MAGDELINA (LCPC , CADC,)
Entity type:Individual
Prefix:
First Name:MAGDELINA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LCPC , CADC,
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12327 RED MESA
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-2682
Mailing Address - Country:US
Mailing Address - Phone:847-704-2812
Mailing Address - Fax:
Practice Address - Street 1:12327 RED MESA
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-2682
Practice Address - Country:US
Practice Address - Phone:224-208-8619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-19
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180012059101YP2500X
TX87996101YP2500X
IL178011444101YP2500X
IL32886101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL178011444Medicaid
IL180012059Medicaid
TX87996Medicaid