Provider Demographics
NPI:1184162869
Name:MARTINEZ HERNANDEZ, CRYSTAL (LBSW)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:MARTINEZ HERNANDEZ
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6207 SHERIDAN AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1060
Mailing Address - Country:US
Mailing Address - Phone:512-334-4411
Mailing Address - Fax:512-334-4465
Practice Address - Street 1:6207 SHERIDAN AVE
Practice Address - Street 2:STE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-1060
Practice Address - Country:US
Practice Address - Phone:512-334-4411
Practice Address - Fax:512-334-4465
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator