Active NPI
Eileen Martinez, LCSW
- Clinical Social Worker
- Mt Prospect, IL
National Provider Identifier
1366801904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149.005636
- Practice address
- 800 E Northwest Hwy
Suite 106
Mt Prospect, IL 60056-3457 - Phone
- (630) 862-0834
- NPI assigned
- Feb 10, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149.005636 | IL | Primary |
Addresses
Primary practice location
800 E Northwest Hwy
Suite 106
Mt Prospect, IL 60056-3457
Mailing address
719 Eberly CT
Plano, IL 60545-2217
Phone (630) 862-0834
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 149.0005636 | Other | IL | STATE OF ILLINOIS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149.005636 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1455062400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1491955200000",
"number": "1366801904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "719 EBERLY CT",
"city": "PLANO",
"state": "IL",
"postal_code": "605452217",
"telephone_number": "630-862-0834"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 E NORTHWEST HWY",
"address_2": "SUITE 106",
"city": "MT PROSPECT",
"state": "IL",
"postal_code": "600563457",
"telephone_number": "630-862-0834"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTINEZ",
"first_name": "EILEEN",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-02-10",
"last_updated": "2017-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149.005636",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF ILLINOIS",
"identifier": "149.0005636",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mt Prospect, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.