Basic Information
| Provider Information | |||||||||
| NPI: | 1205239241 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | MERCEDES | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 630 PLANTATION ST | ||||||||
| Address2: | WOT 12TH FLOOR | ||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016052038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083685532 | ||||||||
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| Practice Location | |||||||||
| Address1: | 425 LAKE AVE N | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016052047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088560732 | ||||||||
| FaxNumber: | 5084255126 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2014 | ||||||||
| LastUpdateDate: | 10/06/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 9998 | MA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.