Provider Demographics
NPI:1366277410
Name:MARTINEZ, BETSEY IVETTE (PSYD)
Entity type:Individual
Prefix:DR
First Name:BETSEY
Middle Name:IVETTE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:BETSEY
Other - Middle Name:
Other - Last Name:MARTINEZ NOBOA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:101 MARKETSIDE AVE STE 404-184
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-1541
Mailing Address - Country:US
Mailing Address - Phone:904-373-8581
Mailing Address - Fax:
Practice Address - Street 1:7901 4TH ST N STE 300
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-4399
Practice Address - Country:US
Practice Address - Phone:904-373-8581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY11895103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical