Provider Demographics
NPI:1639702491
Name:MARTINEZ, RITA ANNE
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:ANNE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2761 JEFFERSON DAVIS HWY STE 107
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-8330
Mailing Address - Country:US
Mailing Address - Phone:571-435-4025
Mailing Address - Fax:888-970-0143
Practice Address - Street 1:8 BRANDONS BLF
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-5300
Practice Address - Country:US
Practice Address - Phone:571-435-4025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 103K00000X
VA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAHRTM6V7OtherKEISER PERMENETE