Provider Demographics
NPI:1477273688
Name:MARTINEZ, JULYSSA NAOMI (MS)
Entity Type:Individual
Prefix:
First Name:JULYSSA
Middle Name:NAOMI
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 PASEO TRIO VEGABAJENO APT 664
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-5847
Mailing Address - Country:US
Mailing Address - Phone:787-629-2598
Mailing Address - Fax:
Practice Address - Street 1:210 PASEO TRIO VEGABAJENO
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-5831
Practice Address - Country:US
Practice Address - Phone:787-629-2598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6825103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling