Provider Demographics
NPI:1437583713
Name:MARTINEZ, DARLENE (MHC PERMIT PEND)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MHC PERMIT PEND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E 149TH ST
Mailing Address - Street 2:APT 15A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-5524
Mailing Address - Country:US
Mailing Address - Phone:917-819-4494
Mailing Address - Fax:
Practice Address - Street 1:579 COURTLANDT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5013
Practice Address - Country:US
Practice Address - Phone:718-485-2100
Practice Address - Fax:718-485-2101
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health