Healthcare Provider Details

I. General information

NPI: 1982032587
Provider Name (Legal Business Name): MIRANDA PAIGE MARTINEZ MSW, LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2013
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 DIXIE HWY
HAMILTON OH
45015-1653
US

IV. Provider business mailing address

4464 S DIXIE HWY
MIDDLETOWN OH
45005-5464
US

V. Phone/Fax

Practice location:
  • Phone: 513-443-2588
  • Fax:
Mailing address:
  • Phone: 513-649-8008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1302649
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: