Provider Demographics
NPI:1093862724
Name:MARTINEZ, MARISOL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARISOL
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E 105TH ST
Mailing Address - Street 2:APT 8G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-5012
Mailing Address - Country:US
Mailing Address - Phone:646-320-7868
Mailing Address - Fax:
Practice Address - Street 1:1543 INWOOD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-2001
Practice Address - Country:US
Practice Address - Phone:718-681-8700
Practice Address - Fax:646-380-1322
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker