Healthcare Provider Details

I. General information

NPI: 1689139545
Provider Name (Legal Business Name): INDIRA MARTINEZ L.C.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2019
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 NW 14TH ST RM 1213
MIAMI FL
33136-2107
US

IV. Provider business mailing address

15130 SW 32ND ST
MIAMI FL
33185-3984
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-6508
  • Fax:
Mailing address:
  • Phone: 786-431-7620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW20042
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: