Provider Demographics
NPI:1700614831
Name:MARTINEZ, EPIMENIA MARCELLA
Entity type:Individual
Prefix:
First Name:EPIMENIA
Middle Name:MARCELLA
Last Name:MARTINEZ
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 1:2528 RIDGE RUNNER RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-4971
Mailing Address - Country:US
Mailing Address - Phone:505-425-2622
Mailing Address - Fax:505-425-9223
Practice Address - Street 1:2528 RIDGE RUNNER RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4971
Practice Address - Country:US
Practice Address - Phone:505-425-2622
Practice Address - Fax:505-425-9223
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2024-0480101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health