Provider Demographics
NPI:1336775832
Name:MARTINEZ, PAOLA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PAOLA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 S RED ACORN CT
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-2191
Mailing Address - Country:US
Mailing Address - Phone:385-645-5120
Mailing Address - Fax:
Practice Address - Street 1:3911 S 3200 W
Practice Address - Street 2:UNIT A
Practice Address - City:WEST VALLEY
Practice Address - State:UT
Practice Address - Zip Code:84119-8411
Practice Address - Country:US
Practice Address - Phone:385-335-4495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 1041S0200X
UT13367758321041C0700X
UT11779966-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool