Provider Demographics
NPI:1437747227
Name:MARTINEZ, MICHAEL A (SW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 446
Mailing Address - Street 2:
Mailing Address - City:SPRINGER
Mailing Address - State:NM
Mailing Address - Zip Code:87747-0446
Mailing Address - Country:US
Mailing Address - Phone:505-398-1567
Mailing Address - Fax:575-383-3337
Practice Address - Street 1:1400 S 2ND ST
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740-2102
Practice Address - Country:US
Practice Address - Phone:505-398-1567
Practice Address - Fax:575-383-3337
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical