Provider Demographics
NPI:1942543772
Name:MARTINEZ, ESMERALDA DEL CARMEN (CADCI)
Entity Type:Individual
Prefix:
First Name:ESMERALDA
Middle Name:DEL CARMEN
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:CADCI
Other - Prefix:
Other - First Name:ESMERALDA
Other - Middle Name:DEL CARMEN
Other - Last Name:HERNANDEZ-MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CADCI
Mailing Address - Street 1:PO BOX 1579
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-1579
Mailing Address - Country:US
Mailing Address - Phone:503-474-2024
Mailing Address - Fax:503-474-4454
Practice Address - Street 1:410 NE 4TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4621
Practice Address - Country:US
Practice Address - Phone:503-474-2024
Practice Address - Fax:503-474-4454
Is Sole Proprietor?:No
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12-P-03101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)