Provider Demographics
NPI:1104719632
Name:MARTINEZ, MAXFIELD MICHAEL (LSW)
Entity type:Individual
Prefix:
First Name:MAXFIELD
Middle Name:MICHAEL
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 N GRANT ST # 5089
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-1859
Mailing Address - Country:US
Mailing Address - Phone:970-825-2778
Mailing Address - Fax:
Practice Address - Street 1:3711 JOHN F KENNEDY PKWY STE 310
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2658
Practice Address - Country:US
Practice Address - Phone:970-825-2778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLSW.0009926362104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker