Provider Demographics
NPI:1902034747
Name:MARTINEZ, ANNETTE HERNANDEZ (LCSW, LCDC, CEAP,SAP)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:HERNANDEZ
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LCSW, LCDC, CEAP,SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 PRAIRIE KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:TX
Mailing Address - Zip Code:77510-8145
Mailing Address - Country:US
Mailing Address - Phone:409-996-3131
Mailing Address - Fax:
Practice Address - Street 1:2245 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-4144
Practice Address - Country:US
Practice Address - Phone:409-996-3131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5645101YA0400X
TX310901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)