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General NPI Number Information
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NPI Number | 1417748807
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Entity Type | Individual
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Provider Name | JESSICA MARTINEZ
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Gender | Female
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Dates
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Enumeration Date | 05/14/2025
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 512 WARREN AVE
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City | SPRING LAKE
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State | NJ
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Zip | 07762-1233
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Country | US
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Telephone | 732-575-0506
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Fax |
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Provider Business Mailing Address
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Address Line | 1901 ELIZABETH AVE UNIT 3153
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City | RAHWAY
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State | NJ
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Zip | 07065-4583
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Country | US
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Telephone | 973-757-7917
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC06437400
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License Number State | NJ
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