Provider Demographics
NPI:1063087484
Name:MARTINEZ, JOSUE (LPC)
Entity type:Individual
Prefix:
First Name:JOSUE
Middle Name:
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 1:9801 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-2009
Mailing Address - Country:US
Mailing Address - Phone:267-341-3232
Mailing Address - Fax:
Practice Address - Street 1:9801 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2009
Practice Address - Country:US
Practice Address - Phone:267-341-3232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2024-01-17
Deactivation Date:2022-06-28
Deactivation Code:
Reactivation Date:2023-03-14
Provider Licenses
StateLicense IDTaxonomies
PAPC015391101YP2500X
PA103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling