Healthcare Provider Details

I. General information

NPI: 1619782513
Provider Name (Legal Business Name): JANELY MARTINEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N MAIN ST
PROVIDENCE RI
02904-5762
US

IV. Provider business mailing address

54 LOOKOUT AVE
CRANSTON RI
02920-7109
US

V. Phone/Fax

Practice location:
  • Phone: 401-276-4020
  • Fax:
Mailing address:
  • Phone: 401-837-4910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCSW04001
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: