Provider Demographics
NPI:1750430302
Name:MARTINEZ, MARIANNA (MS, LBSW)
Entity type:Individual
Prefix:
First Name:MARIANNA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MS, LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7128 MUMRUFFIN LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-5779
Mailing Address - Country:US
Mailing Address - Phone:512-272-4632
Mailing Address - Fax:512-272-4632
Practice Address - Street 1:7128 MUMRUFFIN LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-5779
Practice Address - Country:US
Practice Address - Phone:512-272-4632
Practice Address - Fax:512-272-4632
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35999171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator