MEDICARE: MS. MARIA MERCEDES MARTINEZ

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	067496	NY

General Provider Information

NPI Number	:	1467594788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIA MERCEDES MARTINEZ

Provider Business Mailing Address
First Line	:	42 HICKS ST
Second Line	:	#9
City	:	BROOKLYN
State	:	NY
Zip	:	11201-6905
Country	:	US
Telephone Number	:	646-265-3049
Fax Number	:

Provider Business Practice Location Address
First Line	:	3764 72ND STREET
Second Line	:	QUEENS COUNTY NEUROPSYCHIATRIC INST
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-6143
Country	:	US
Telephone Number	:	718-335-3434
Fax Number	:	718-335-4731

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	07/08/2007

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