Provider Demographics
NPI:1699141085
Name:MARTINEZ, TIFFANY (LCSW)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5980 S COOPER RD STE 3
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-5394
Mailing Address - Country:US
Mailing Address - Phone:480-705-7300
Mailing Address - Fax:800-530-9132
Practice Address - Street 1:20185 E OCOTILLO RD STE 104
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-7663
Practice Address - Country:US
Practice Address - Phone:480-704-3474
Practice Address - Fax:888-221-2541
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW74762104100000X
FLTPSW34551041C0700X
AZLCSW-206871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker