Provider Demographics
NPI:1083223648
Name:MARTINEZ, ADALIZETH (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:ADALIZETH
Middle Name:
Last Name:MARTINEZ
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 1:847 S RANDALL RD # 360
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-3002
Mailing Address - Country:US
Mailing Address - Phone:877-360-8360
Mailing Address - Fax:
Practice Address - Street 1:2520 WATERMARK TER UNIT 309
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60124-3013
Practice Address - Country:US
Practice Address - Phone:224-409-5478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490208981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical