Provider Demographics
NPI:1750519302
Name:MARTORANO, CRYSTAL NICOLE (BS)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:NICOLE
Last Name:MARTORANO
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:NICOLE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:2558 20TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-1703
Mailing Address - Country:US
Mailing Address - Phone:541-968-1670
Mailing Address - Fax:
Practice Address - Street 1:2558 20TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1703
Practice Address - Country:US
Practice Address - Phone:541-968-1670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health