Provider Demographics
NPI:1053079004
Name:OBANDO, YAMILETH MARTINEZ (LCSW)
Entity Type:Individual
Prefix:
First Name:YAMILETH
Middle Name:MARTINEZ
Last Name:OBANDO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1264 BOA TRL
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-9010
Mailing Address - Country:US
Mailing Address - Phone:562-644-7684
Mailing Address - Fax:
Practice Address - Street 1:777 W ARMY TRAIL BLVD
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-3163
Practice Address - Country:US
Practice Address - Phone:630-403-8123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490230601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical