Provider Demographics
NPI:1881036184
Name:MARTINEZ, ERICA (LPC)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GROVE STREET
Mailing Address - Street 2:STE 201
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053
Mailing Address - Country:US
Mailing Address - Phone:860-612-8613
Mailing Address - Fax:860-294-4766
Practice Address - Street 1:1 GROVE STREET
Practice Address - Street 2:STE 201
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053
Practice Address - Country:US
Practice Address - Phone:860-612-8613
Practice Address - Fax:860-294-4766
Is Sole Proprietor?:No
Enumeration Date:2013-07-27
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2676101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT12802445OtherCAQH
CT5102893OtherCIGNA BEHAVIORAL HEALTH
CT008064335Medicaid
CTD339225 PINE STREETOtherVALUE OPTIONS
CT5561804OtherAETNA BEHAVIORAL HEALTH
CT008064335Medicaid
CT060669107OtherUBH-UNITED HEALTH CARE WELLMORE GRP/FACILITY
CT060669107OtherUBH LIBERTY/FREEDOM OXFORD HEALTH WELLMORE GRP/FACILITY
CTNOT ELIGIBLEMedicare PIN
CT060669107OtherHEALTHY CT/WELLMORE INC- FACILITY/GRP
CTPENDINGOtherMHN MANAGED HEALTH NETWORK
CT060669107OtherUNITED BEHAVIORAL HEALTH WELLMORE GRP/FACILITY
CT12802445OtherCAQH
CT5102893OtherCIGNA BEHAVIORAL HEALTH