Provider Demographics
NPI:1588356810
Name:AVILEZ-MARTINEZ, ROSA JAZMIN (LLMSW)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:JAZMIN
Last Name:AVILEZ-MARTINEZ
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:MI
Mailing Address - Zip Code:49455-8201
Mailing Address - Country:US
Mailing Address - Phone:231-902-8550
Mailing Address - Fax:
Practice Address - Street 1:525 N STATE ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:MI
Practice Address - Zip Code:49455-8201
Practice Address - Country:US
Practice Address - Phone:231-902-8550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851116067104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker