Provider Demographics
NPI:1578924478
Name:MARTINEZ, ALETHEA (CSW)
Entity Type:Individual
Prefix:
First Name:ALETHEA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5226 FRONTIER DR
Mailing Address - Street 2:
Mailing Address - City:MORGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84050-9734
Mailing Address - Country:US
Mailing Address - Phone:801-550-1513
Mailing Address - Fax:801-876-3697
Practice Address - Street 1:5226 FRONTIER DR
Practice Address - Street 2:
Practice Address - City:MORGAN
Practice Address - State:UT
Practice Address - Zip Code:84050-9734
Practice Address - Country:US
Practice Address - Phone:801-550-1513
Practice Address - Fax:801-876-3697
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-19
Last Update Date:2016-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT290651-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical