MEDICARE: MARIA MARTINEZ M.A., PH.D.

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	103TC2200X	Clinical Child & Adolescent Psychologist	0810005574	VA

General Provider Information

NPI Number	:	1457528804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA MARTINEZ M.A., PH.D.

Provider Business Mailing Address
First Line	:	2100 WASHINGTON BLVD
Second Line	:	3RD FL
City	:	ARLINGTON
State	:	VA
Zip	:	22204-5703
Country	:	US
Telephone Number	:	703-228-1550
Fax Number	:	703-228-1171

Provider Business Practice Location Address
First Line	:	2100 WASHINGTON BLVD
Second Line	:	3RD FL
City	:	ARLINGTON
State	:	VA
Zip	:	22204-5703
Country	:	US
Telephone Number	:	703-228-1550
Fax Number	:	703-228-1171

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

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	12/23/2016

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