Healthcare Provider Details

I. General information

NPI: 1053973511
Provider Name (Legal Business Name): LISANDRA MARTINEZ MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2019
Last Update Date: 01/10/2026
Certification Date: 01/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 CALLE MAYOR
PONCE PR
00730-3726
US

IV. Provider business mailing address

PO BOX 8851
PONCE PR
00732-8851
US

V. Phone/Fax

Practice location:
  • Phone: 787-844-3077
  • Fax: 787-844-3077
Mailing address:
  • Phone: 787-844-3077
  • Fax: 787-844-3077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8775
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14024
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: