Provider Demographics
NPI:1912320367
Name:FUENTES-MARTINEZ, ELIZABETH (LMHC-MA ED)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:FUENTES-MARTINEZ
Suffix:
Gender:F
Credentials:LMHC-MA ED
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:FUENTES-MARTINEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYCHOTHERAPIST
Mailing Address - Street 1:2438 TIEMANN AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-6206
Mailing Address - Country:US
Mailing Address - Phone:917-436-7950
Mailing Address - Fax:718-881-4399
Practice Address - Street 1:2438 TIEMANN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-6206
Practice Address - Country:US
Practice Address - Phone:347-961-8399
Practice Address - Fax:718-881-4399
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-21
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005810101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health