Individual
MRS. JANETTE MARTINEZ-LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
QMHP, MA
Contact information
Practice address
5341 W CERMAK RD, CICERO, IL 60804-2817
(773) 656-6430
(708) 656-6591
Mailing address
2544 N AVERS AVE, CHICAGO, IL 60647-1071
(708) 656-6430
(708) 656-6591
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1617631
BLUE CROSS BLUE SHIELD
IL
01
—
202591
MEDICARE
IL
05
—
362246705
—
IL
Enumeration date
03/23/2007
Last updated
09/17/2008
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