Basic Information
| Provider Information | |||||||||
| NPI: | 1073829545 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | SANITAGO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 348 13TH ST STE 203 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112156179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187885101 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 350 BEACH 88TH ST | ||||||||
| Address2: | |||||||||
| City: | ROCKAWAY BEACH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 116931421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185364379 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2010 | ||||||||
| LastUpdateDate: | 06/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 06/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041S0200X | 0899109 | NY | N | Behavioral Health & Social Service Providers | Social Worker | School | 104100000X | 80898 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.