Provider Demographics
NPI:1740007830
Name:MADRID, MARTINA HERNANDEZ (PSY D)
Entity type:Individual
Prefix:DR
First Name:MARTINA
Middle Name:HERNANDEZ
Last Name:MADRID
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 CHARLELA LN APT 206
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VLG
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3241
Mailing Address - Country:US
Mailing Address - Phone:432-212-9013
Mailing Address - Fax:
Practice Address - Street 1:1660 FEEHANVILLE DR STE 400
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-6036
Practice Address - Country:US
Practice Address - Phone:847-981-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03345103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical