Healthcare Provider Details

I. General information

NPI: 1366927428
Provider Name (Legal Business Name): EMMA MARTINEZ-BEILDECK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N ROSE ST
PHOENIX OR
97535-5734
US

IV. Provider business mailing address

931 CHEVY WAY
MEDFORD OR
97504-4127
US

V. Phone/Fax

Practice location:
  • Phone: 541-535-6239
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberL10501
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: