Provider Demographics
NPI:1659751832
Name:MARTINEZ, KATELYN
Entity Type:Individual
Prefix:MS
First Name:KATELYN
Middle Name:
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 1:23 TWILIGHT TER
Mailing Address - Street 2:
Mailing Address - City:LOUDONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12211-2224
Mailing Address - Country:US
Mailing Address - Phone:518-649-2472
Mailing Address - Fax:
Practice Address - Street 1:26 CENTURY HILL DR STE 205
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2110
Practice Address - Country:US
Practice Address - Phone:518-288-8055
Practice Address - Fax:518-309-6589
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006602101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health