Provider Demographics
NPI:1902167984
Name:MARTINEZ, CHRISTINA R (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:R
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:SLACKTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:123 W CHANDLER HEIGHTS RD UNIT 11113
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-1006
Mailing Address - Country:US
Mailing Address - Phone:480-744-7411
Mailing Address - Fax:
Practice Address - Street 1:765 W LOCUST DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-4474
Practice Address - Country:US
Practice Address - Phone:480-744-7411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-128681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ711049Medicaid