Healthcare Provider Details

I. General information

NPI: 1568689206
Provider Name (Legal Business Name): RENEE TORREZ MARTINEZ LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4932 RIO CEBOLLA CT. NW
ALBUQUERQUE NM
87114
US

IV. Provider business mailing address

4932 RIO CEBOLLA CT. NW
ALBUQUERQUE NM
87114
US

V. Phone/Fax

Practice location:
  • Phone: 505-892-6630
  • Fax:
Mailing address:
  • Phone: 505-892-6630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-2862
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: