Provider Demographics
NPI:1972236289
Name:MARTINEZ, KIMBER JOY (LCSW)
Entity type:Individual
Prefix:
First Name:KIMBER
Middle Name:JOY
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KIMBER
Other - Middle Name:JOY
Other - Last Name:NICOLETTI-MARTINEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1630 KLONDIKE RD
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-4801
Mailing Address - Country:US
Mailing Address - Phone:765-491-0566
Mailing Address - Fax:
Practice Address - Street 1:1630 KLONDIKE RD
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-4801
Practice Address - Country:US
Practice Address - Phone:765-491-0566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34007727A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical