Provider Demographics
NPI:1952032989
Name:MARTINEZ MATEOS, LETICIA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:MARTINEZ MATEOS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WINDRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46011-1227
Mailing Address - Country:US
Mailing Address - Phone:323-506-7798
Mailing Address - Fax:
Practice Address - Street 1:1700 N ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1316
Practice Address - Country:US
Practice Address - Phone:317-554-5700
Practice Address - Fax:317-931-5113
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34010306A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical