Provider Demographics
NPI:1053453308
Name:MARTINEZ, JAVIER (MED)
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:U
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 BLACKBERRY LN
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-1516
Mailing Address - Country:US
Mailing Address - Phone:312-204-0314
Mailing Address - Fax:
Practice Address - Street 1:63 BLACKBERRY LN
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-1516
Practice Address - Country:US
Practice Address - Phone:312-204-0314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2024-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MA8851101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor