Provider Demographics
NPI:1528230414
Name:MARTINEZ, PAULINE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:PAULINE
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:PAULINE
Other - Middle Name:
Other - Last Name:MAESTAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:EMBUDO
Mailing Address - State:NM
Mailing Address - Zip Code:87531-0310
Mailing Address - Country:US
Mailing Address - Phone:505-579-4253
Mailing Address - Fax:505-579-4016
Practice Address - Street 1:225 GRAND AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-3832
Practice Address - Country:US
Practice Address - Phone:505-454-9611
Practice Address - Fax:505-454-8079
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT0109071101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)