Provider Demographics
NPI:1306102017
Name:MARTINEZ, SHARILIZ
Entity type:Individual
Prefix:
First Name:SHARILIZ
Middle Name:
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 1:1160 WHITNEY ST
Mailing Address - Street 2:
Mailing Address - City:BURNS HARBOR
Mailing Address - State:IN
Mailing Address - Zip Code:46304-9674
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1160 WHITNEY ST
Practice Address - Street 2:
Practice Address - City:BURNS HARBOR
Practice Address - State:IN
Practice Address - Zip Code:46304-9674
Practice Address - Country:US
Practice Address - Phone:219-973-6807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker