Provider Demographics
NPI:1982491619
Name:MARTINEZ, CARMEN MARGARITA
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:MARGARITA
Last Name:MARTINEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 W WASHINGTON ST STE 220
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8237
Mailing Address - Country:US
Mailing Address - Phone:312-668-0261
Mailing Address - Fax:
Practice Address - Street 1:123 W WASHINGTON ST STE 220
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8237
Practice Address - Country:US
Practice Address - Phone:312-668-0261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.021229101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional