Provider Demographics
NPI:1992873756
Name:MARTINEZ, ALEXANDER (LCSWR)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 E MEADOW AVE UNIT 723
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-6024
Mailing Address - Country:US
Mailing Address - Phone:347-651-0900
Mailing Address - Fax:888-901-8693
Practice Address - Street 1:109 N 12TH ST FL 8
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-1008
Practice Address - Country:US
Practice Address - Phone:347-651-0900
Practice Address - Fax:888-901-8693
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077662R1041C0700X
NY7949441041S0200X
NY0776621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03403610Medicaid