MEDICARE: ANNA MARIE MARTINEZ LMSW

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	1041C0700X	Clinical Social Worker	M08494	NM

General Provider Information

NPI Number	:	1063961647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA MARIE MARTINEZ LMSW

Provider Business Mailing Address
First Line	:	4963 STAR KACHINA ST NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-2424
Country	:	US
Telephone Number	:	505-400-6613
Fax Number	:

Provider Business Practice Location Address
First Line	:	4963 STAR KACHINA ST NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-2424
Country	:	US
Telephone Number	:	505-400-6613
Fax Number	:

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

Provider Enumeration Date	:	09/23/2016
Last Update Date	:	09/23/2016

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