Healthcare Provider Details

I. General information

NPI: 1528470432
Provider Name (Legal Business Name): CHRISTA MARTINEZ LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 EDWARDS WAY APT 915
ADELPHI MD
20783-3459
US

IV. Provider business mailing address

9200 EDWARDS WAY APT 915
ADELPHI MD
20783-3459
US

V. Phone/Fax

Practice location:
  • Phone: 316-993-5483
  • Fax: 405-286-1730
Mailing address:
  • Phone: 316-993-5483
  • Fax: 405-286-1730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberU/S
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: