Provider Demographics
NPI:1407246382
Name:MARTINEZ, ROGER GERARDO (BSW)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:GERARDO
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-660 MOANALUA LOOP APT 180
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-5152
Mailing Address - Country:US
Mailing Address - Phone:808-954-0329
Mailing Address - Fax:
Practice Address - Street 1:875 WAIMANU ST STE 624
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5265
Practice Address - Country:US
Practice Address - Phone:808-791-6613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health