Provider Demographics
NPI:1205003720
Name:MARTINEZ, DEVA (EDS)
Entity Type:Individual
Prefix:
First Name:DEVA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 BLOOMINGDALE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-6132
Mailing Address - Country:US
Mailing Address - Phone:870-476-3437
Mailing Address - Fax:
Practice Address - Street 1:3405 BLOOMINGDALE OAKS DR
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-6132
Practice Address - Country:US
Practice Address - Phone:870-476-3437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1403101YA0400X
ARP1103014101YM0800X
NC14152101YP1600X
FLMH15370101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral