Provider Demographics
NPI:1093010621
Name:MARTINEZ, IDELKA (MSED)
Entity Type:Individual
Prefix:
First Name:IDELKA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8238 229TH ST
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-2154
Mailing Address - Country:US
Mailing Address - Phone:347-579-8795
Mailing Address - Fax:
Practice Address - Street 1:8238 229TH ST
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-2154
Practice Address - Country:US
Practice Address - Phone:347-579-8795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst