Healthcare Provider Details

I. General information

NPI: 1801207816
Provider Name (Legal Business Name): JANINE JOHANNA MARTINEZ-SALAZAR MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 05/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 BICKFORD ST
JAMAICA PLAIN MA
02130-1401
US

IV. Provider business mailing address

4 DALRYMPLE ST APT.2
JAMAICA PLAIN MA
02130-4539
US

V. Phone/Fax

Practice location:
  • Phone: 617-971-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number219365
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: