Individual
MR. FIDEL RICARDO MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW, CEAP
Contact information
Practice address
720 45TH ST, MUNSTER, IN 46321-2818
(219) 852-2513
(219) 852-2443
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
149001127
IL
1041C0700X
Clinical Social Worker
Primary
34004064A
IN
1041C0700X
Clinical Social Worker
87000616A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
90000854
BCBSIL
IL
Enumeration date
08/01/2006
Last updated
10/11/2023
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