Healthcare Provider Details

I. General information

NPI: 1053709717
Provider Name (Legal Business Name): AUSTRIA MARTINEZ MHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 E 172ND ST
BRONX NY
10460-5802
US

IV. Provider business mailing address

150 E 45TH ST
NEW YORK NY
10017-3115
US

V. Phone/Fax

Practice location:
  • Phone: 347-767-2200
  • Fax:
Mailing address:
  • Phone: 212-949-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number006151-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: