Provider Demographics
NPI:1326468596
Name:MARTINEZ, MARIBEL (LBSW)
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
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 1:865 ANTHONY DR
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:NM
Mailing Address - Zip Code:88021-9354
Mailing Address - Country:US
Mailing Address - Phone:575-882-5858
Mailing Address - Fax:575-882-3063
Practice Address - Street 1:865 ANTHONY DR
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:NM
Practice Address - Zip Code:88021-9354
Practice Address - Country:US
Practice Address - Phone:575-882-5858
Practice Address - Fax:575-882-3063
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMB-05211104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker