Provider Demographics
NPI:1790302412
Name:VALERIO MARTINEZ, ISHA MARIE (MSW)
Entity Type:Individual
Prefix:PROF
First Name:ISHA
Middle Name:MARIE
Last Name:VALERIO MARTINEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. VILLA DEL CARMEN AVE. CONSTANCIA
Mailing Address - Street 2:#4407
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:787-382-0218
Mailing Address - Fax:
Practice Address - Street 1:URB VILLA DEL CARMEN AVE CONSTANCIA
Practice Address - Street 2:4407
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-382-0218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR243011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical