Provider Demographics
NPI:1053899971
Name:MARTINEZ, JESSICA (MPSY)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MPSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 CAMINO DE LAS TRINITARIAS
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-9686
Mailing Address - Country:US
Mailing Address - Phone:787-223-4442
Mailing Address - Fax:
Practice Address - Street 1:309 CAMINO DE LAS TRINITARIAS
Practice Address - Street 2:
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778-9686
Practice Address - Country:US
Practice Address - Phone:787-223-4442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6078103T00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist