Provider Demographics
NPI:1205277589
Name:MACIAS-MARTINEZ, JULIETA I (LCSW-C, PHD)
Entity type:Individual
Prefix:MS
First Name:JULIETA
Middle Name:I
Last Name:MACIAS-MARTINEZ
Suffix:
Gender:F
Credentials:LCSW-C, PHD
Other - Prefix:DR
Other - First Name:JULIETA
Other - Middle Name:
Other - Last Name:MACIAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-C, PHD
Mailing Address - Street 1:800
Mailing Address - Street 2:S FREDERICK AVE. SUITE 200A
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877
Mailing Address - Country:US
Mailing Address - Phone:240-380-7901
Mailing Address - Fax:240-235-7015
Practice Address - Street 1:800
Practice Address - Street 2:S FREDERICK AVE. SUITE 200A
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877
Practice Address - Country:US
Practice Address - Phone:240-380-7901
Practice Address - Fax:240-235-7015
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD165741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical