Provider Demographics
NPI:1629582150
Name:MARTINEZ, LAZARO
Entity Type:Individual
Prefix:
First Name:LAZARO
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:
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:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-1018
Mailing Address - Country:US
Mailing Address - Phone:207-498-6431
Mailing Address - Fax:
Practice Address - Street 1:43 HATCH DR
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-2161
Practice Address - Country:US
Practice Address - Phone:207-493-3361
Practice Address - Fax:207-492-4889
Is Sole Proprietor?:No
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor