MEDICARE: VERONICA MARTINEZ

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	103K00000X	Behavior Analyst	374376	IL

General Provider Information

NPI Number	:	1831783380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERONICA MARTINEZ

Provider Business Mailing Address
First Line	:	3552 S ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-1317
Country	:	US
Telephone Number	:	773-543-3828
Fax Number	:

Provider Business Practice Location Address
First Line	:	11301 S HARLEM AVE
Second Line	:
City	:	WORTH
State	:	IL
Zip	:	60482-2001
Country	:	US
Telephone Number	:	708-586-2604
Fax Number	:

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

Provider Enumeration Date	:	02/25/2021
Last Update Date	:	02/25/2021

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Directions to “ VERONICA MARTINEZ ” Practice Location

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