MEDICARE: SAMANTHA 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	P014813	NC

General Provider Information

NPI Number	:	1275298283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA MARTINEZ LCSW

Provider Business Mailing Address
First Line	:	156 YORK DR
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-6897
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5046 GRAYS CREEK CHURCH RD
Second Line	:
City	:	HOPE MILLS
State	:	NC
Zip	:	28348-7812
Country	:	US
Telephone Number	:	910-493-3555
Fax Number	:	910-493-3520

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

Provider Enumeration Date	:	11/04/2021
Last Update Date	:	05/25/2024

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