Provider Demographics
NPI:1720418692
Name:MARTINEZ, SUSAN E (LMHP4280 MSW(1662) L)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LMHP4280 MSW(1662) L
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:E
Other - Last Name:CLOTHIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2626 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361
Mailing Address - Country:US
Mailing Address - Phone:308-633-3726
Mailing Address - Fax:308-633-2847
Practice Address - Street 1:2626 BROADWAY
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69341
Practice Address - Country:US
Practice Address - Phone:308-633-3726
Practice Address - Fax:308-633-2847
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8745101YM0800X
NELCSW4820101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health