Provider Demographics
NPI:1669939542
Name:MARTINEZ, JUSTINA FRANCINE
Entity type:Individual
Prefix:
First Name:JUSTINA
Middle Name:FRANCINE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 OLD AIRPORT RD NW APT 2422
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-9293
Mailing Address - Country:US
Mailing Address - Phone:505-450-8699
Mailing Address - Fax:
Practice Address - Street 1:3550 OLD AIRPORT RD NW APT 2422
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-9293
Practice Address - Country:US
Practice Address - Phone:505-450-8699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
NMM-117681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst