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General NPI Number Information
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NPI Number | 1982822896
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Entity Type | Individual
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Provider Name | NINFA A MARTINEZ MA
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Gender | Female
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 02/09/2012
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Provider Practice Location Address
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Address Line | 1535 BURGUNDY PKWY
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City | STREAMWOOD
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State | IL
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Zip | 60107-1811
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Country | US
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Telephone | 773-392-6274
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Fax |
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Provider Business Mailing Address
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Address Line | 600 N MCCLURG CT SUITE 4411-A
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City | CHICAGO
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State | IL
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Zip | 60611-3044
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Country | US
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Telephone | 773-392-6274
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180002020
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 166000458
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License Number State | IL
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