Provider Demographics
NPI:1841478260
Name:MARTINEZ, ELLIE ELISA (MSW)
Entity type:Individual
Prefix:MS
First Name:ELLIE
Middle Name:ELISA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 MIDDLETOWN RD
Mailing Address - Street 2:16
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-5341
Mailing Address - Country:US
Mailing Address - Phone:718-710-6671
Mailing Address - Fax:
Practice Address - Street 1:217 HAVEMEYER ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-6277
Practice Address - Country:US
Practice Address - Phone:718-963-4430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical