Provider Demographics
NPI:1962972315
Name:MARTINEZ, NICOLE (CADC)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CORBETT WAY
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-4247
Mailing Address - Country:US
Mailing Address - Phone:732-380-7061
Mailing Address - Fax:732-380-7058
Practice Address - Street 1:1 CORBETT WAY
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-4247
Practice Address - Country:US
Practice Address - Phone:732-380-7061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37CA00109700101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37CA00109700OtherALCOHOL AND DRUG COUNSELING COMMITTEE