Provider Demographics
NPI:1578980314
Name:MARTINEZ, ELIZABETH E (PH D)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:E
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:E
Other - Last Name:MARINEZ-VEGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1801 AVE PONCE DE LEON
Mailing Address - Street 2:SUITE 311
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-1900
Mailing Address - Country:US
Mailing Address - Phone:787-727-2424
Mailing Address - Fax:787-726-7281
Practice Address - Street 1:1801 AVE PONCE DE LEON
Practice Address - Street 2:SUITE 311
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-1900
Practice Address - Country:US
Practice Address - Phone:787-727-2424
Practice Address - Fax:787-726-7281
Is Sole Proprietor?:No
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1366103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical