Provider Demographics
NPI:1780012617
Name:MARTINEZ, PAULINA (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:PAULINA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 SE 11TH CT STE A
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1111
Mailing Address - Country:US
Mailing Address - Phone:954-764-7155
Mailing Address - Fax:954-764-6083
Practice Address - Street 1:514 SE 11TH CT STE A
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1111
Practice Address - Country:US
Practice Address - Phone:954-764-7155
Practice Address - Fax:954-764-6083
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW45941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical