Provider Demographics
NPI:1568085256
Name:MARTINEZ, MARC A (PHD, ABPP)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:A
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1018
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-5018
Mailing Address - Country:US
Mailing Address - Phone:585-232-1288
Mailing Address - Fax:
Practice Address - Street 1:510 CLINTON SQ
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14604-1700
Practice Address - Country:US
Practice Address - Phone:585-232-1288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018798-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical