Provider Demographics
NPI:1437817673
Name:MARTINEZ ALICEA, KATHIRIA
Entity Type:Individual
Prefix:
First Name:KATHIRIA
Middle Name:
Last Name:MARTINEZ ALICEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CALLE JOAQUINA
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-1200
Mailing Address - Country:US
Mailing Address - Phone:939-223-9403
Mailing Address - Fax:
Practice Address - Street 1:CAROLINA SHOPPING COURT, SUITE 201A
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982
Practice Address - Country:US
Practice Address - Phone:787-767-8758
Practice Address - Fax:844-759-2966
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7187103T00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR39276100Medicaid