Provider Demographics
NPI:1861006116
Name:MARTINEZ RODRIGUEZ, KERTIN (CBHCMS)
Entity type:Individual
Prefix:
First Name:KERTIN
Middle Name:
Last Name:MARTINEZ RODRIGUEZ
Suffix:
Gender:F
Credentials:CBHCMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12001 SW 128TH CT STE 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4665
Mailing Address - Country:US
Mailing Address - Phone:786-975-7585
Mailing Address - Fax:954-860-7166
Practice Address - Street 1:12001 SW 128TH CT STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4665
Practice Address - Country:US
Practice Address - Phone:786-975-7585
Practice Address - Fax:954-860-7166
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker