Provider Demographics
NPI:1669584108
Name:MARTINO, KARA MARIE (MS)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:MARIE
Last Name:MARTINO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:MARIE
Other - Last Name:LIDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:19758 KEVIN CT
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-3504
Mailing Address - Country:US
Mailing Address - Phone:708-821-8954
Mailing Address - Fax:
Practice Address - Street 1:9435 BORMET DR STE 5
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-7401
Practice Address - Country:US
Practice Address - Phone:708-995-7226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006335101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health