Provider Demographics
NPI:1689794729
Name:MARTINEZ, PEDRO R (MC,MHC,CPL)
Entity Type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:R
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MC,MHC,CPL
Other - Prefix:MR
Other - First Name:PEDRO
Other - Middle Name:R
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MC,MHC,CPL
Mailing Address - Street 1:F22 CALLE ARAGON
Mailing Address - Street 2:VILLA CONTESA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-2778
Mailing Address - Country:US
Mailing Address - Phone:787-662-6837
Mailing Address - Fax:
Practice Address - Street 1:F22 CALLE ARAGON
Practice Address - Street 2:VILLA CONTESA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-2778
Practice Address - Country:US
Practice Address - Phone:787-662-6837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1451101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health