Provider Demographics
NPI:1083081517
Name:ROMERO MARTINEZ, ILLAMI
Entity Type:Individual
Prefix:
First Name:ILLAMI
Middle Name:
Last Name:ROMERO MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 KEYSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4039
Mailing Address - Country:US
Mailing Address - Phone:517-321-7663
Mailing Address - Fax:
Practice Address - Street 1:6415 STANLEY AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3130
Practice Address - Country:US
Practice Address - Phone:708-995-3815
Practice Address - Fax:708-788-8535
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-01
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist