Provider Demographics
NPI:1114368982
Name:MARTINEZ, SUSANA ISABEL
Entity Type:Individual
Prefix:DR
First Name:SUSANA
Middle Name:ISABEL
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 W 59TH ST
Mailing Address - Street 2:APT 10B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1086
Mailing Address - Country:US
Mailing Address - Phone:212-875-0342
Mailing Address - Fax:
Practice Address - Street 1:555 W 59TH ST
Practice Address - Street 2:APT 10B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1086
Practice Address - Country:US
Practice Address - Phone:212-875-0342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000464103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis