Healthcare Provider Details

I. General information

NPI: 1578935110
Provider Name (Legal Business Name): MARIA MARTINEZ MHPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2015
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 KELLEY HWY
FORT SMITH AR
72904-5000
US

IV. Provider business mailing address

3617 CHAFFEE DR
FORT SMITH AR
72904-6509
US

V. Phone/Fax

Practice location:
  • Phone: 479-785-5700
  • Fax:
Mailing address:
  • Phone: 479-459-8258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13001-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: