Provider Demographics
NPI:1679294599
Name:MARTINEZ-PESANTE, FABIOLA NAHIR (PHD)
Entity type:Individual
Prefix:MISS
First Name:FABIOLA
Middle Name:NAHIR
Last Name:MARTINEZ-PESANTE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 N CAMPBELL AVE UNIT 203N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-0014
Mailing Address - Country:US
Mailing Address - Phone:787-975-3235
Mailing Address - Fax:
Practice Address - Street 1:3046 W ARMITAGE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-5935
Practice Address - Country:US
Practice Address - Phone:872-588-6011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1073183554OtherN/A