MEDICARE: MRS. LISANDRA MARTINEZ MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	8775	PR
2	1041C0700X	Clinical Social Worker	14024	PR

General Provider Information

NPI Number	:	1053973511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISANDRA MARTINEZ MSW

Provider Business Mailing Address
First Line	:	PO BOX 8851
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00732-8851
Country	:	US
Telephone Number	:	787-844-3077
Fax Number	:	787-844-3077

Provider Business Practice Location Address
First Line	:	35 CALLE MAYOR
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00730-3726
Country	:	US
Telephone Number	:	787-844-3077
Fax Number	:	787-844-3077

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2019
Last Update Date	:	01/10/2026

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