MEDICARE: CAROLINA MARTINEZ LCSW

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	SW20286	FL

General Provider Information

NPI Number	:	1215659024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINA MARTINEZ LCSW

Provider Business Mailing Address
First Line	:	1117 LEHTO LN
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-5359
Country	:	US
Telephone Number	:	954-557-1408
Fax Number	:

Provider Business Practice Location Address
First Line	:	1117 LEHTO LN
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-5359
Country	:	US
Telephone Number	:	954-557-1408
Fax Number	:

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

Provider Enumeration Date	:	09/19/2022
Last Update Date	:	09/19/2022

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