Provider Demographics
NPI:1790545440
Name:ROSALES, MARTA I (MHP)
Entity Type:Individual
Prefix:MRS
First Name:MARTA
Middle Name:I
Last Name:ROSALES
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 INGLESHIRE RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-2047
Mailing Address - Country:US
Mailing Address - Phone:346-402-9506
Mailing Address - Fax:
Practice Address - Street 1:309 NEW INDIAN TRAIL CT
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-2411
Practice Address - Country:US
Practice Address - Phone:630-966-4139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health