Provider Demographics
NPI:1346465911
Name:MARTINEZ, CARLOS ROMUALDO (LCSW)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:ROMUALDO
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:548 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-1262
Mailing Address - Country:US
Mailing Address - Phone:732-316-2391
Mailing Address - Fax:732-316-2348
Practice Address - Street 1:548 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-1262
Practice Address - Country:US
Practice Address - Phone:732-316-2391
Practice Address - Fax:732-316-2348
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00027400101YA0400X
NJ44SC046498001041C0700X
NJ37FI00156200106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist