Provider Demographics
NPI:1801593595
Name:MARTINEZ ESTRADA, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MARTINEZ ESTRADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 E PELELIU DR
Mailing Address - Street 2:
Mailing Address - City:TARAWA TERRACE
Mailing Address - State:NC
Mailing Address - Zip Code:28543-1196
Mailing Address - Country:US
Mailing Address - Phone:804-931-2560
Mailing Address - Fax:
Practice Address - Street 1:CAMP LEJEUNE NAVAL HOSPITAL
Practice Address - Street 2:100 BREWSTER BLVD
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28542
Practice Address - Country:US
Practice Address - Phone:804-931-2560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR153161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical