Provider Demographics
NPI:1982166575
Name:MARTINEZ, ERIN KATHARINE (LMSW)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:KATHARINE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 WEST DL INGRAM AVE
Mailing Address - Street 2:
Mailing Address - City:CANNON AIR FORCE BASE
Mailing Address - State:NM
Mailing Address - Zip Code:88101-5508
Mailing Address - Country:US
Mailing Address - Phone:575-784-1108
Mailing Address - Fax:
Practice Address - Street 1:224 W DL INGRAM
Practice Address - Street 2:
Practice Address - City:CANNON AIR FORCE BASE
Practice Address - State:NM
Practice Address - Zip Code:88101
Practice Address - Country:US
Practice Address - Phone:575-781-1108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-112871041C0700X
CT0117001041C0700X
NMM-010234104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker