Provider Demographics
NPI:1386728657
Name:MARTINEZ, ANA LYDIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANA
Middle Name:LYDIA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6850 LANDINGS DR APT 202
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-5076
Mailing Address - Country:US
Mailing Address - Phone:954-731-9465
Mailing Address - Fax:
Practice Address - Street 1:3301 COLLEGE AVENUE - MALTZ BLDG
Practice Address - Street 2:NSU - PSYCHOLOGY SERVICES CENTER
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33314
Practice Address - Country:US
Practice Address - Phone:954-262-5831
Practice Address - Fax:954-262-3855
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSY5519103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical