Provider Demographics
NPI:1912047374
Name:MARTINEZ, SYLVIA JEAN (MA,LBSW, LPC)
Entity Type:Individual
Prefix:MRS
First Name:SYLVIA
Middle Name:JEAN
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MA,LBSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 CARLOS TRL
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-6728
Mailing Address - Country:US
Mailing Address - Phone:361-396-0499
Mailing Address - Fax:361-668-3033
Practice Address - Street 1:613 LUCERO ST
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-5850
Practice Address - Country:US
Practice Address - Phone:361-396-0499
Practice Address - Fax:361-668-3033
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63084101Y00000X
TX22894171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1806077Medicaid
TX186446402Medicaid