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General NPI Number Information
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NPI Number | 1780309369
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Entity Type | Individual
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Provider Name | DAFNE MARTINEZ
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Gender | Female
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Dates
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Enumeration Date | 10/06/2022
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Last Update Date | 01/12/2024
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Provider Practice Location Address
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Address Line | 3228 S PULASKI RD
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City | CHICAGO
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State | IL
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Zip | 60623-4919
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Country | US
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Telephone | 773-827-6109
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Fax |
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Provider Business Mailing Address
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Address Line | 2433 N WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60647-2028
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Country | US
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Telephone | 773-827-6109
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 11697733
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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