Provider Demographics
NPI:1861047821
Name:MARTINEZ, STEPHANIE ANNE (LGMFT)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:ANNE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LGMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 N GARFIELD ST APT 442
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-2565
Mailing Address - Country:US
Mailing Address - Phone:915-346-6779
Mailing Address - Fax:
Practice Address - Street 1:5652 SHIELDS DR
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-3574
Practice Address - Country:US
Practice Address - Phone:240-225-0522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGM738106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1386161305OtherCAREFIRST BCBS