MEDICARE: NIA L MARTINEZ LISW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	I-07611	NM

General Provider Information

NPI Number	:	1124267711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIA L MARTINEZ LISW

Provider Business Mailing Address
First Line	:	2218 W. GRAND AVE
Second Line	:
City	:	ARTESIA
State	:	NM
Zip	:	88211-0155
Country	:	US
Telephone Number	:	575-317-2109
Fax Number	:	575-748-6160

Provider Business Practice Location Address
First Line	:	2218 W. GRAND AVE
Second Line	:
City	:	ARTESIA
State	:	NM
Zip	:	88211-0155
Country	:	US
Telephone Number	:	575-317-2109
Fax Number	:	575-748-6160

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2009
Last Update Date	:	09/10/2014

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Directions to “ NIA L MARTINEZ LISW” Practice Location

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