Healthcare Provider Details

I. General information

NPI: 1821292244
Provider Name (Legal Business Name): CYNTHIA MARIA MARTINEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST
BRONX NY
10467-2401
US

IV. Provider business mailing address

1415 WHITE PLAINS RD
BRONX NY
10462-4103
US

V. Phone/Fax

Practice location:
  • Phone: 718-547-2789
  • Fax: 718-547-2881
Mailing address:
  • Phone: 718-430-9363
  • Fax: 718-547-2881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number075400
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: