Provider Demographics
NPI:1346855921
Name:MARTINEZ, FELICIA ROSARIO (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:ROSARIO
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 COUNTY ROAD A6
Mailing Address - Street 2:
Mailing Address - City:SAPELLO
Mailing Address - State:NM
Mailing Address - Zip Code:87745-5031
Mailing Address - Country:US
Mailing Address - Phone:505-429-9681
Mailing Address - Fax:
Practice Address - Street 1:211 COUNTY ROAD A6
Practice Address - Street 2:
Practice Address - City:SAPELLO
Practice Address - State:NM
Practice Address - Zip Code:87745-5031
Practice Address - Country:US
Practice Address - Phone:505-429-9681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-09463104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty