Provider Demographics
NPI:1346940079
Name:MARTINEZ GUALAJARA, BRENDA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:
Last Name:MARTINEZ GUALAJARA
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 1:1355 S HIGLEY RD STE 113
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-4789
Mailing Address - Country:US
Mailing Address - Phone:480-339-7119
Mailing Address - Fax:
Practice Address - Street 1:1355 S HIGLEY RD STE 113
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4789
Practice Address - Country:US
Practice Address - Phone:480-339-7119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-18851104100000X
AZLCSW-218121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker