Provider Demographics
NPI:1124567797
Name:MARTINEZ, ANA MARIA (MSSA, LISW)
Entity Type:Individual
Prefix:
First Name:ANA MARIA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MSSA, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19610 PURITAS AVE APT 136
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135-1086
Mailing Address - Country:US
Mailing Address - Phone:513-532-3125
Mailing Address - Fax:
Practice Address - Street 1:1228 EUCLID AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-1834
Practice Address - Country:US
Practice Address - Phone:216-970-8864
Practice Address - Fax:216-619-6192
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.16003551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical