Provider Demographics
NPI:1356622609
Name:MARTINEZ, MARIA XIOMARA (LMSW)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:XIOMARA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAVEN AVE APT.#5H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033
Mailing Address - Country:US
Mailing Address - Phone:917-750-1472
Mailing Address - Fax:
Practice Address - Street 1:200 HAVEN AVE
Practice Address - Street 2:APT.# 5H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-5348
Practice Address - Country:US
Practice Address - Phone:917-750-1472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070434104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker