Provider Demographics
NPI:1487309043
Name:MARTINEZ, ROBERTO CARLOS (LPC)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:CARLOS
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 BELLE VIEW BLVD # 5069
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22307-6531
Mailing Address - Country:US
Mailing Address - Phone:571-528-1500
Mailing Address - Fax:
Practice Address - Street 1:6000 EDSALL RD APT 103
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-5800
Practice Address - Country:US
Practice Address - Phone:571-528-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-12
Last Update Date:2022-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011003101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health