Provider Demographics
NPI:1376242206
Name:MARTINEZ, JACQUELINE LISSETTE (LMFT, LMHC, NCC)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:LISSETTE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LMFT, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8310 SW 114TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3625
Mailing Address - Country:US
Mailing Address - Phone:305-321-7661
Mailing Address - Fax:
Practice Address - Street 1:4343 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1586
Practice Address - Country:US
Practice Address - Phone:954-543-0698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT4485101YP2500X
FLMH21440101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional