Healthcare Provider Details

I. General information

NPI: 1740356377
Provider Name (Legal Business Name): CARMEN MARTINEZ TITTMANN MA LPCC LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4686 CORRALES RD
CORRALES NM
87048
US

IV. Provider business mailing address

PO BOX 3204
CORRALES NM
87048
US

V. Phone/Fax

Practice location:
  • Phone: 505-890-3327
  • Fax: 505-898-6327
Mailing address:
  • Phone: 505-890-3327
  • Fax: 505-898-6327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1587
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM2126
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1587
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: