Provider Demographics
NPI:1720625916
Name:MARTINEZ, NATALIA MARIE (LPC MED)
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:MARIE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LPC MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1663 AVE AMERICO MIRANDA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-2429
Mailing Address - Country:US
Mailing Address - Phone:939-334-6848
Mailing Address - Fax:
Practice Address - Street 1:1663 AVE AMERICO MIRANDA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-2429
Practice Address - Country:US
Practice Address - Phone:939-334-6848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4295101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4295OtherCOUNSELOR LICENSE