Provider Demographics
NPI:1972329357
Name:MARTINEZ, CRYSTAL L (MSW)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:L
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 MORIN HEIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-2236
Mailing Address - Country:US
Mailing Address - Phone:401-209-0150
Mailing Address - Fax:
Practice Address - Street 1:191 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-7244
Practice Address - Country:US
Practice Address - Phone:401-781-3990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW03865101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty