Provider Demographics
NPI:1063081008
Name:MARTINEZ, SAMANDA YVELISE I
Entity type:Individual
Prefix:MRS
First Name:SAMANDA
Middle Name:YVELISE
Last Name:MARTINEZ
Suffix:I
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SAMANDA
Other - Middle Name:
Other - Last Name:MARTINEZ
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:5043 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-2644
Mailing Address - Country:US
Mailing Address - Phone:215-744-4343
Mailing Address - Fax:
Practice Address - Street 1:5043 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-2644
Practice Address - Country:US
Practice Address - Phone:215-744-4343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health