Provider Demographics
NPI:1265193833
Name:MARTINO, JESSICA VICTORIA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:VICTORIA
Last Name:MARTINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3032 BAKERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-4107
Mailing Address - Country:US
Mailing Address - Phone:865-456-9599
Mailing Address - Fax:
Practice Address - Street 1:6000 WALDEN DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-6358
Practice Address - Country:US
Practice Address - Phone:865-321-1405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional