Provider Demographics
NPI:1023749454
Name:LIDIA MARTINEZ PHD LLC
Entity type:Organization
Organization Name:LIDIA MARTINEZ PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIDIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMHC, MCAP
Authorized Official - Phone:786-565-6916
Mailing Address - Street 1:13520 SW 152ND ST UNIT 771513
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-0178
Mailing Address - Country:US
Mailing Address - Phone:786-565-6916
Mailing Address - Fax:305-260-6200
Practice Address - Street 1:13520 SW 152ND ST UNIT 771513
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-0178
Practice Address - Country:US
Practice Address - Phone:786-565-6916
Practice Address - Fax:305-260-6200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)