Provider Demographics
NPI:1164868832
Name:MARTIN, CRISTINA RODRIGUEZ (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:RODRIGUEZ
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 SUMNER ST
Mailing Address - Street 2:#3
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-2220
Mailing Address - Country:US
Mailing Address - Phone:781-820-1825
Mailing Address - Fax:
Practice Address - Street 1:414 SUMNER ST
Practice Address - Street 2:#3
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-2220
Practice Address - Country:US
Practice Address - Phone:781-820-1825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2186681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical