Provider Demographics
NPI:1497990923
Name:MARTINEZ, ANA IRIS
Entity Type:Individual
Prefix:MRS
First Name:ANA
Middle Name:IRIS
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:17 WEST MERRICK ROARD
Mailing Address - Street 2:SOUTH SHORE CHILD GUIDE CENTER
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3892
Mailing Address - Country:US
Mailing Address - Phone:516-868-3030
Mailing Address - Fax:
Practice Address - Street 1:17 WEST MERRICK ROAD
Practice Address - Street 2:17
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3892
Practice Address - Country:US
Practice Address - Phone:516-868-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health