Provider Demographics
NPI:1033593702
Name:MARTINEZ, LISA V (RCSWI)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:V
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5648 92ND TER N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-5008
Mailing Address - Country:US
Mailing Address - Phone:727-458-3909
Mailing Address - Fax:
Practice Address - Street 1:5648 92ND TER N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-5008
Practice Address - Country:US
Practice Address - Phone:727-458-3909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW95281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical