Healthcare Provider Details

I. General information

NPI: 1134513278
Provider Name (Legal Business Name): JESSICA J MARTINEZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 N STATE RT 17 STE 100
PARAMUS NJ
07652-2648
US

IV. Provider business mailing address

95 N STATE RT 17 STE 100
PARAMUS NJ
07652-2648
US

V. Phone/Fax

Practice location:
  • Phone: 732-982-2888
  • Fax: 973-594-0536
Mailing address:
  • Phone: 732-982-2888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00806900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00806900
License Number State
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: