Healthcare Provider Details

I. General information

NPI: 1891514972
Provider Name (Legal Business Name): JOSE R MARTINEZ LICENSED MENTAL HEALTH COUNSELOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 LINCOLN ST
NEW ROCHELLE NY
10801-4336
US

IV. Provider business mailing address

69 LINCOLN ST
NEW ROCHELLE NY
10801-4336
US

V. Phone/Fax

Practice location:
  • Phone: 914-727-0152
  • Fax:
Mailing address:
  • Phone: 914-727-0152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE R MARTINEZ RAPHAEL MARTINEZ
Title or Position: MENTAL HEALTH COUNSELOR
Credential:
Phone: 914-727-0152