Provider Demographics
NPI:1992417604
Name:MARTINEZ, NATHANAEL R (MA)
Entity type:Individual
Prefix:
First Name:NATHANAEL
Middle Name:R
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10051 COUNTRY RD BLDG C
Mailing Address - Street 2:
Mailing Address - City:WEEKI WACHEE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5264
Mailing Address - Country:US
Mailing Address - Phone:941-275-9659
Mailing Address - Fax:
Practice Address - Street 1:10051 COUNTRY RD BLDG C
Practice Address - Street 2:
Practice Address - City:WEEKI WACHEE
Practice Address - State:FL
Practice Address - Zip Code:34613-5264
Practice Address - Country:US
Practice Address - Phone:941-275-9659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-14
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT4532106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist