Provider Demographics
NPI:1225187859
Name:MARTINEZ, BRENDA MANSFIELD (LBSW)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:MANSFIELD
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 SAN ANTONIO ST
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76541-7944
Mailing Address - Country:US
Mailing Address - Phone:254-519-4953
Mailing Address - Fax:254-519-4953
Practice Address - Street 1:1505 SAN ANTONIO ST
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-7944
Practice Address - Country:US
Practice Address - Phone:254-519-4953
Practice Address - Fax:254-519-4953
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17607171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator