Provider Demographics
NPI:1467692608
Name:MARTINEZ, CARMEN M (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:M
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BRISMAN DR
Mailing Address - Street 2:
Mailing Address - City:THIELLS
Mailing Address - State:NY
Mailing Address - Zip Code:10984-1441
Mailing Address - Country:US
Mailing Address - Phone:917-807-1919
Mailing Address - Fax:845-942-4473
Practice Address - Street 1:25 BRISMAN DR
Practice Address - Street 2:
Practice Address - City:THIELLS
Practice Address - State:NY
Practice Address - Zip Code:10984-1441
Practice Address - Country:US
Practice Address - Phone:917-807-1919
Practice Address - Fax:845-942-4473
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-28
Last Update Date:2009-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040313-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical