Provider Demographics
NPI:1609581602
Name:MARTINEZ, TIFFANI UNIQUE (LMFT)
Entity Type:Individual
Prefix:
First Name:TIFFANI
Middle Name:UNIQUE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:TIFFANI
Other - Middle Name:UNIQUE
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:873 WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-4153
Mailing Address - Country:US
Mailing Address - Phone:860-209-9749
Mailing Address - Fax:
Practice Address - Street 1:873 WEST BLVD
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-4153
Practice Address - Country:US
Practice Address - Phone:860-209-9749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3247106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2749Medicaid