Provider Demographics
NPI:1598045734
Name:MARTINEZ, MARIA TERESA (LSW)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:TERESA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:TERESA
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RETIRED
Mailing Address - Street 1:8428 98TH ST
Mailing Address - Street 2:APT 2
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-1735
Mailing Address - Country:US
Mailing Address - Phone:718-210-3335
Mailing Address - Fax:
Practice Address - Street 1:8428 98TH STREET
Practice Address - Street 2:APT 2
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421
Practice Address - Country:US
Practice Address - Phone:718-210-3335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR043998390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program