Provider Demographics
NPI:1366749665
Name:MARTINEZ, HEATHER S
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:S
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 1:6330 RIVERSIDE PLAZA LN NW STE 260
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2160
Mailing Address - Country:US
Mailing Address - Phone:505-226-2839
Mailing Address - Fax:505-295-2559
Practice Address - Street 1:6330 RIVERSIDE PLAZA LN NW STE 260
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-2160
Practice Address - Country:US
Practice Address - Phone:505-226-2839
Practice Address - Fax:505-295-2559
Is Sole Proprietor?:No
Enumeration Date:2011-02-22
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
NMCTB-2024-0379101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM29122350Medicaid