Provider Demographics
NPI:1134739337
Name:MARTINEZ, LIDIA ALEJANDRA (PHD LMHC MCAP CTP)
Entity type:Individual
Prefix:
First Name:LIDIA
Middle Name:ALEJANDRA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PHD LMHC MCAP CTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 1:6705 S RED RD STE 512
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3644
Practice Address - Country:US
Practice Address - Phone:786-565-6916
Practice Address - Fax:305-260-6200
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLADC-011071-2015101YA0400X
FL5227101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty