Provider Demographics
NPI:1801428602
Name:MARTINEZ, CHASSTIRY VAZQUEZ (LCSW)
Entity type:Individual
Prefix:
First Name:CHASSTIRY
Middle Name:VAZQUEZ
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHASSTIRY
Other - Middle Name:
Other - Last Name:VAZQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6853 FALLEN ROCK ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-2582
Mailing Address - Country:US
Mailing Address - Phone:702-378-3166
Mailing Address - Fax:
Practice Address - Street 1:2500 CHANDLER AVE STE 3
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-4064
Practice Address - Country:US
Practice Address - Phone:725-204-8809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10407-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical