Healthcare Provider Details

I. General information

NPI: 1083983357
Provider Name (Legal Business Name): WILDA MARTINEZ LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2011
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 WEIRFIELD ST
BROOKLYN NY
11237-6113
US

IV. Provider business mailing address

341 WEIRFIELD ST
BROOKLYN NY
11237-6113
US

V. Phone/Fax

Practice location:
  • Phone: 347-471-6176
  • Fax:
Mailing address:
  • Phone: 347-471-6176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number082166-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number081354-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR081354-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: