Provider Demographics
NPI:1992187298
Name:MARTINEZ, TESHA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:TESHA
Middle Name:
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 1:105 PASEO DEL CANON W STE A
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6943
Mailing Address - Country:US
Mailing Address - Phone:575-737-5533
Mailing Address - Fax:
Practice Address - Street 1:105 PASEO DEL CANON W STE A
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6943
Practice Address - Country:US
Practice Address - Phone:575-737-5533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical