Provider Demographics
NPI:1053432062
Name:MARTINEZ, KRISTINA LEE
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:LEE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KRISTINA
Other - Middle Name:LEE
Other - Last Name:HAMPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:47 SALEM ST
Mailing Address - Street 2:APT.#2
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-5640
Mailing Address - Country:US
Mailing Address - Phone:413-218-4813
Mailing Address - Fax:
Practice Address - Street 1:100 ERDMAN WAY
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-1804
Practice Address - Country:US
Practice Address - Phone:978-466-8389
Practice Address - Fax:978-537-3496
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health