Provider Demographics
NPI:1346823820
Name:MARTINEZ, MARIA ANDREA (LMSW)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ANDREA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12702 TOEPPERWEIN RD
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3278
Mailing Address - Country:US
Mailing Address - Phone:210-286-9339
Mailing Address - Fax:210-951-8962
Practice Address - Street 1:12702 TOEPPERWEIN RD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3278
Practice Address - Country:US
Practice Address - Phone:210-286-9339
Practice Address - Fax:210-951-8962
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104444104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX831668503Medicaid