Provider Demographics
NPI:1235439936
Name:MARTINEZ EIDE, KATHERINE LEANA (MSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LEANA
Last Name:MARTINEZ EIDE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:LEANA
Other - Last Name:MARTINEZ-DICKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1823 NE 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3907
Mailing Address - Country:US
Mailing Address - Phone:503-460-2796
Mailing Address - Fax:503-460-3750
Practice Address - Street 1:1823 NE 8TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3907
Practice Address - Country:US
Practice Address - Phone:503-460-2796
Practice Address - Fax:503-460-3750
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker