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General NPI Number Information
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NPI Number | 1770367906
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Entity Type | Individual
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Provider Name | EDWARD CONRADO MARTINEZ LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/21/2023
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 187 S CANAAN RD
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City | CANAAN
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State | CT
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Zip | 06018-2544
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Country | US
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Telephone | 877-200-0637
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Fax | 860-945-4282
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Provider Business Mailing Address
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Address Line | 110 N MAIN ST
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City | WINSTED
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State | CT
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Zip | 06098-1740
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Country | US
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Telephone | 860-201-3414
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 03-045639
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License Number State | CT
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