Provider Demographics
NPI:1194456194
Name:MARTINEZ, GLADYS
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:GLADYS
Other - Middle Name:
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED , LAC
Mailing Address - Street 1:833 GIBBONS CT
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-3106
Mailing Address - Country:US
Mailing Address - Phone:908-280-1403
Mailing Address - Fax:
Practice Address - Street 1:833 GIBBONS CT
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-3106
Practice Address - Country:US
Practice Address - Phone:908-280-1403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional