Provider Demographics
NPI:1902131691
Name:MARTINEZ, LUANN (LSAA)
Entity type:Individual
Prefix:MS
First Name:LUANN
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LSAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 MAIN ST NW # D-16
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-4849
Mailing Address - Country:US
Mailing Address - Phone:505-866-0590
Mailing Address - Fax:
Practice Address - Street 1:1000 MAIN ST NW # D-16
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-4849
Practice Address - Country:US
Practice Address - Phone:505-866-0590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0122031101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)