Provider Demographics
NPI:1043414253
Name:MARTINEZ, JOAQUIN JR (CADC)
Entity Type:Individual
Prefix:MR
First Name:JOAQUIN
Middle Name:JR
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 REED DR
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-1142
Mailing Address - Country:US
Mailing Address - Phone:860-912-9181
Mailing Address - Fax:
Practice Address - Street 1:23 REED DR
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-1142
Practice Address - Country:US
Practice Address - Phone:860-912-9181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTA-4059-SA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor