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General NPI Number Information
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NPI Number | 1376088542
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Entity Type | Individual
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Provider Name | MARY-ELLEN MARTINEZ PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 12/27/2016
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Last Update Date | 04/27/2021
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Provider Practice Location Address
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Address Line | 2800 S CALIFORNIA AVE
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City | CHICAGO
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State | IL
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Zip | 60608-5107
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Country | US
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Telephone | 312-674-0065
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Fax |
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Provider Business Mailing Address
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Address Line | 830 PAISLEY CT
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City | NAPERVILLE
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State | IL
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Zip | 60540-6204
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Country | US
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Telephone | 312-439-1741
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.009420
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License Number State | IL
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