Provider Demographics
NPI:1053079004
Name:OBANDO, YAMILETH MARTINEZ (LCSW)
Entity type:Individual
Prefix:
First Name:YAMILETH
Middle Name:MARTINEZ
Last Name:OBANDO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:YAMILETH
Other - Middle Name:
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:132 W LAKE ST OFC 7
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1020
Mailing Address - Country:US
Mailing Address - Phone:630-597-3854
Mailing Address - Fax:
Practice Address - Street 1:132 W LAKE ST OFC 7
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1020
Practice Address - Country:US
Practice Address - Phone:630-597-3854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490230601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical