Active NPI
Kimberly Lisa Smith-Martinez, PHD
- Psychologist
- Oak Park, IL
National Provider Identifier
1871667980
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 071.008583
- Practice address
- 110 S Euclid Ave
Oak Park, IL 60302-2906 - Phone
- (210) 854-6786
- Fax
- (708) 613-5254
- NPI assigned
- Nov 20, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 30587 | TX | |
| Psychologist | 103T00000X | 071.008583 | IL | Primary |
Addresses
Primary practice location
110 S Euclid Ave
Oak Park, IL 60302-2906
Mailing address
110 S Euclid Ave
Oak Park, IL 60302-2906
Phone (210) 854-6786
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 040555701 | Medicaid | TX |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071.008583 | IL | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1417478400000",
"number": "1871667980",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 S EUCLID AVE",
"city": "OAK PARK",
"state": "IL",
"postal_code": "603022906",
"telephone_number": "210-854-6786"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 S EUCLID AVE",
"city": "OAK PARK",
"state": "IL",
"postal_code": "603022906",
"telephone_number": "210-854-6786",
"fax_number": "708-613-5254"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH-MARTINEZ",
"first_name": "KIMBERLY",
"middle_name": "LISA",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-20",
"last_updated": "2014-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "TX",
"license": "30587",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "IL",
"license": "071.008583",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "040555701",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oak Park, IL
- Linda D. Small, PH.D.
- Smart Behavior Solutions (Serrano Counseling and Behavior Solutions)
- Smart Love Parenting Center (Pediatric Counseling Center)
- Leslie Smebak, MD
- Smile You Re Golden
- Breona Porche Smith
- Elizabeth M Smith, DPT
- Kelly Therese Smith, ATC, LAT
- Lawrence Patrick Smith, DDS
- Maliya Smith, MS, LPC., CKYT 200
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.