Provider Demographics
NPI:1366456493
Name:MARTINEZ, ABIGAIL (LCSW)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ABIGAIL
Other - Middle Name:
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:200 HAVEN AVE APT 4L
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-5307
Mailing Address - Country:US
Mailing Address - Phone:212-928-1568
Mailing Address - Fax:
Practice Address - Street 1:241 CENTRAL PARK W APT 1C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-4544
Practice Address - Country:US
Practice Address - Phone:917-613-8773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR035262-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical