Provider Demographics
NPI:1477005163
Name:MARTINEZ, JOSE (MS)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-4336
Mailing Address - Country:US
Mailing Address - Phone:914-380-0117
Mailing Address - Fax:
Practice Address - Street 1:69 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-4336
Practice Address - Country:US
Practice Address - Phone:914-380-0117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-27
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012982101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health