Healthcare Provider Details

I. General information

NPI: 1255713129
Provider Name (Legal Business Name): RAFAEL MAURICIO MARTINEZ L.S.C.W
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2015
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 DIVISION AVE APT 24A
BROOKLYN NY
11249-6614
US

IV. Provider business mailing address

60 DIVISION AVE APT 24A
BROOKLYN NY
11249-6614
US

V. Phone/Fax

Practice location:
  • Phone: 917-397-6193
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number087470-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: