Provider Demographics
NPI:1619650223
Name:MARTELL MALDONADO, LEDYS KARINA I
Entity Type:Individual
Prefix:
First Name:LEDYS
Middle Name:KARINA
Last Name:MARTELL MALDONADO
Suffix:I
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 1:937 N ASHLAND AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-6031
Mailing Address - Country:US
Mailing Address - Phone:939-638-2191
Mailing Address - Fax:
Practice Address - Street 1:7222 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:NORTH RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-1422
Practice Address - Country:US
Practice Address - Phone:866-695-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician