Individual
KIMBERLY LISA SMITH-MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
110 S EUCLID AVE, OAK PARK, IL 60302-2906
(210) 854-6786
(708) 613-5254
Mailing address
110 S EUCLID AVE, OAK PARK, IL 60302-2906
(210) 854-6786
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
071.008583
IL
103T00000X
Psychologist
30587
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
040555701
—
TX
Enumeration date
11/20/2006
Last updated
12/02/2014
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