Healthcare Provider Details

I. General information

NPI: 1497611040
Provider Name (Legal Business Name): GABRIELA MARTINEZ LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8745 W HIGGINS RD
CHICAGO IL
60631-2704
US

IV. Provider business mailing address

4158 N MEADE AVE APT 2
CHICAGO IL
60634-1505
US

V. Phone/Fax

Practice location:
  • Phone: 708-255-6414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number150.112449
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: