Provider Demographics
NPI:1215157516
Name:MARTINEZ, JUANITA MARTINEZ (MSW)
Entity type:Individual
Prefix:MISS
First Name:JUANITA
Middle Name:MARTINEZ
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MISS
Other - First Name:JUANITA
Other - Middle Name:MARTINEZ
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:AVE. SAN IGNASIO , APT.# 12N, S.J. P.R
Mailing Address - Street 2:COND.SAN IGNASIO, APT. 12N, S.J. P.R
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-3836
Mailing Address - Country:US
Mailing Address - Phone:787-758-3709
Mailing Address - Fax:787-758-3709
Practice Address - Street 1:CALLE MAGA . BO. MONACILLOS , SJ, #B
Practice Address - Street 2:CALLE MAGA . BO. MONACILLOS ,AMBULATORIO SJ, #B
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-758-3709
Practice Address - Fax:787-758-3709
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical