Healthcare Provider Details

I. General information

NPI: 1699611376
Provider Name (Legal Business Name): MINERVA MARTINEZ LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 ATLANTIC AVE STE 118
BROOKLYN NY
11217-1704
US

IV. Provider business mailing address

460 ATLANTIC AVE STE 118
BROOKLYN NY
11217-1704
US

V. Phone/Fax

Practice location:
  • Phone: 718-222-1518
  • Fax:
Mailing address:
  • Phone: 718-222-1518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number128833-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: