Provider Demographics
NPI:1528732278
Name:MARTINEZ, CARIANNE (PSYD)
Entity type:Individual
Prefix:
First Name:CARIANNE
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5404 IBIS CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-2630
Mailing Address - Country:US
Mailing Address - Phone:919-412-7640
Mailing Address - Fax:
Practice Address - Street 1:4000 SHIPYARD BLVD STE 100
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6194
Practice Address - Country:US
Practice Address - Phone:910-792-5570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist