Provider Demographics
NPI:1447596028
Name:MARTINEZ, KEITH H (LCSW, LCADC)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:H
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CORBETT WAY
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-4247
Mailing Address - Country:US
Mailing Address - Phone:732-380-7061
Mailing Address - Fax:732-380-7508
Practice Address - Street 1:1 CORBETT WAY
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-4247
Practice Address - Country:US
Practice Address - Phone:732-380-7061
Practice Address - Fax:732-380-7508
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-30
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00155000101YA0400X
NJ44SC051874001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)