Provider Demographics
NPI:1215549951
Name:MARTINEZ, ROSALIA (MASTER OF SCIENCE)
Entity Type:Individual
Prefix:MRS
First Name:ROSALIA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MASTER OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 702
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77516-0702
Mailing Address - Country:US
Mailing Address - Phone:979-997-0051
Mailing Address - Fax:877-789-7991
Practice Address - Street 1:6302 BROADWAY ST STE 235
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-7828
Practice Address - Country:US
Practice Address - Phone:979-997-0051
Practice Address - Fax:877-789-7991
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80275101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional