Provider Demographics
NPI:1154164531
Name:MARTINEZ FLORIAN, RAQUEL
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:
Last Name:MARTINEZ FLORIAN
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 1:33 WOLCOTT ST
Mailing Address - Street 2:APT 1
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02121-3726
Mailing Address - Country:US
Mailing Address - Phone:774-712-7071
Mailing Address - Fax:
Practice Address - Street 1:33 WOLCOTT ST
Practice Address - Street 2:APT 1
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02121-3726
Practice Address - Country:US
Practice Address - Phone:774-712-7071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106S00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No172V00000XOther Service ProvidersCommunity Health Worker