Provider Demographics
NPI:1265238190
Name:MARTINEZ, JESSICA YAMILEX (LCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:YAMILEX
Last Name:MARTINEZ
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 SOMERVELLE ST APT 106
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-8212
Mailing Address - Country:US
Mailing Address - Phone:703-867-6980
Mailing Address - Fax:
Practice Address - Street 1:4370 RIDGEWOOD CENTER DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5348
Practice Address - Country:US
Practice Address - Phone:703-863-8929
Practice Address - Fax:703-792-5098
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040178621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical