Provider Demographics
NPI:1932351004
Name:MARTINEZ, MOLLY S (PHD)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:S
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:S
Other - Last Name:SNODGRASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1701 N COLLINS BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3553
Mailing Address - Country:US
Mailing Address - Phone:214-810-4667
Mailing Address - Fax:614-929-3615
Practice Address - Street 1:1701 N COLLINS BLVD STE 230
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3553
Practice Address - Country:US
Practice Address - Phone:214-810-4667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37466103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1932351004Medicaid