Provider Demographics
NPI:1376298497
Name:MARTELL, LILLIAM (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:LILLIAM
Middle Name:
Last Name:MARTELL
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 SW 39TH CT
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2054
Mailing Address - Country:US
Mailing Address - Phone:305-215-1390
Mailing Address - Fax:
Practice Address - Street 1:575 SW 39TH CT
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2054
Practice Address - Country:US
Practice Address - Phone:305-215-1390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH20278101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health