Provider Demographics
NPI:1205321189
Name:MARTINEZ-CALLERI, RAQUEL
Entity type:Individual
Prefix:MS
First Name:RAQUEL
Middle Name:
Last Name:MARTINEZ-CALLERI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 SENECA PKWY
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14613-1415
Mailing Address - Country:US
Mailing Address - Phone:585-230-0510
Mailing Address - Fax:
Practice Address - Street 1:2613 W HENRIETTA RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2327
Practice Address - Country:US
Practice Address - Phone:585-230-0510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-24
Last Update Date:2018-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082068-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty