MEDICARE: MISS JADE ERIN MARTINEZ LLBSW

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	104100000X	Social Worker	6802088045	MI

General Provider Information

NPI Number	:	1265851653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JADE ERIN MARTINEZ LLBSW

Provider Business Mailing Address
First Line	:	8415 HURON RIVER DR
Second Line	:
City	:	WHITE LAKE
State	:	MI
Zip	:	48386-2519
Country	:	US
Telephone Number	:	248-881-9070
Fax Number	:

Provider Business Practice Location Address
First Line	:	8415 HURON RIVER DR
Second Line	:
City	:	WHITE LAKE
State	:	MI
Zip	:	48386-2519
Country	:	US
Telephone Number	:	248-881-9070
Fax Number	:

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

Provider Enumeration Date	:	04/14/2014
Last Update Date	:	04/14/2014

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