Provider Demographics
NPI:1831321827
Name:MARTINEZ, GRISEL (HT)
Entity Type:Individual
Prefix:MRS
First Name:GRISEL
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:HT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8361 NW 24TH PL
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-3327
Mailing Address - Country:US
Mailing Address - Phone:954-854-9041
Mailing Address - Fax:
Practice Address - Street 1:8361 NW 24TH PL
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33322-3327
Practice Address - Country:US
Practice Address - Phone:954-854-9041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL061809-9041101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor