Provider Demographics
NPI:1780469197
Name:MARTINEZ, ALFONSO ANDRES (LCPC)
Entity type:Individual
Prefix:
First Name:ALFONSO
Middle Name:ANDRES
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 DUNLAY CT APT 1E
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-4572
Mailing Address - Country:US
Mailing Address - Phone:224-610-9797
Mailing Address - Fax:
Practice Address - Street 1:2405 DUNLAY CT APT 1E
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-4572
Practice Address - Country:US
Practice Address - Phone:224-610-9795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.019293101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty