Provider Demographics
NPI:1093277253
Name:MARTINEZ, NICOLE RACHEL (LLP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:RACHEL
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:RACHEL
Other - Last Name:FRIEDLAENDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TLLP
Mailing Address - Street 1:30150 TELEGRAPH RD STE 245
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4521
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30150 TELEGRAPH RD STE 245
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4521
Practice Address - Country:US
Practice Address - Phone:800-693-1916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301018348103T00000X
390200000X
MI6361007646103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program