MEDICARE: TIFFANY 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	104100000X	Social Worker	ASW74762	CA
2	1041C0700X	Clinical Social Worker	TPSW3455	FL
3	1041C0700X	Clinical Social Worker	LCSW-20687	AZ

General Provider Information

NPI Number	:	1699141085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY MARTINEZ LCSW

Provider Business Mailing Address
First Line	:	5980 S COOPER RD STE 3
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85249-5394
Country	:	US
Telephone Number	:	480-705-7300
Fax Number	:	800-530-9132

Provider Business Practice Location Address
First Line	:	20185 E OCOTILLO RD STE 104
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-7663
Country	:	US
Telephone Number	:	480-704-3474
Fax Number	:	888-221-2541

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

Provider Enumeration Date	:	08/19/2015
Last Update Date	:	02/13/2024

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