Provider Demographics
NPI:1952691917
Name:MARTINEZ, DEBRA ALICIA (PC)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ALICIA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:ALICIA MAE
Other - Last Name:HUTCHINS, WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 RED MAPLE TRAIL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1515
Mailing Address - Country:US
Mailing Address - Phone:608-692-9827
Mailing Address - Fax:
Practice Address - Street 1:6333 ODANA ROAD
Practice Address - Street 2:SUITE 20
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1170
Practice Address - Country:US
Practice Address - Phone:608-270-2511
Practice Address - Fax:608-270-0467
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI671-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional