MEDICARE: MRS. LISA M. MARTIRENA LCPC, MT-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	180008411	IL

General Provider Information

NPI Number	:	1720210719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA M. MARTIRENA LCPC, MT-BC

Provider Business Mailing Address
First Line	:	10540 S WESTERN AVE
Second Line	:	STE. 200
City	:	CHICAGO
State	:	IL
Zip	:	60643-2536
Country	:	US
Telephone Number	:	773-319-8138
Fax Number	:

Provider Business Practice Location Address
First Line	:	10540 S WESTERN AVE
Second Line	:	STE. 200
City	:	CHICAGO
State	:	IL
Zip	:	60643-2536
Country	:	US
Telephone Number	:	773-319-8138
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2009
Last Update Date	:	04/19/2013

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