MEDICARE: MR. RAFAEL 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	6201001	AZ

General Provider Information

NPI Number	:	1952409385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAFAEL MARTINEZ LCSW

Provider Business Mailing Address
First Line	:	6726 N 15TH PL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-1134
Country	:	US
Telephone Number	:	602-561-7062
Fax Number	:	602-294-0408

Provider Business Practice Location Address
First Line	:	6726 N 15TH PL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-1134
Country	:	US
Telephone Number	:	602-561-7062
Fax Number	:	602-294-0408

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	10/21/2008

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