Doctor Name: | MR. LEO MICHAEL MARTINEZ |
NPI Number: | 1124415864 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 2012021499 |
Business Practice Address: | 1150 State Highway 248 Ste 202 Branson, MO - 656163758 |
Business Phone Number: | 4173488494 |
Business Fax Number: | |
Mailing Address: | Po Box 4046, SPRINGFIELD |
State: | MO |
Postal Code: | 658084046 |
Phone Number: | 4173488494 |
Fax Number: | |
NPI Enumeration Date: | 04/21/2015 |
NPI Last Update Date: | 04/21/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 2012021499 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |