Healthcare Provider Details

I. General information

NPI: 1164942637
Provider Name (Legal Business Name): MELISSA LIDIA MARTINEZ LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17615 FRANJO RD
PALMETTO BAY FL
33157-5636
US

IV. Provider business mailing address

8970 SW 226TH TER
CUTLER BAY FL
33190-1326
US

V. Phone/Fax

Practice location:
  • Phone: 786-268-2611
  • Fax: 786-268-1748
Mailing address:
  • Phone: 786-749-8666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT5182
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: