Provider Demographics
NPI:1801497086
Name:MARTINEZ, LIDICE (CBHCMS)
Entity type:Individual
Prefix:
First Name:LIDICE
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:CBHCMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11245 SW 227TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170-3511
Mailing Address - Country:US
Mailing Address - Phone:786-720-1027
Mailing Address - Fax:
Practice Address - Street 1:717 PONCE DE LEON BLVD STE 324
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2050
Practice Address - Country:US
Practice Address - Phone:786-343-6493
Practice Address - Fax:305-397-1271
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker