Provider Demographics
NPI:1518576248
Name:MARTINEZ, RAYMOND ANTHONY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:ANTHONY
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 SLEEPY HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-5702
Mailing Address - Country:US
Mailing Address - Phone:972-795-5350
Mailing Address - Fax:
Practice Address - Street 1:702 SLEEPY HOLLOW DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-5702
Practice Address - Country:US
Practice Address - Phone:972-795-5350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX627621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX62762OtherTSBSWE