Basic Information
| Provider Information | |||||||||
| NPI: | 1457517021 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | GLENDA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 JENNISON ST | ||||||||
| Address2: | |||||||||
| City: | BAY CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487087846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344742205 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1320 N MICHIGAN AVE STE 5 | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486024751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894019015 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2008 | ||||||||
| LastUpdateDate: | 06/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | MI | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 6801095968 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.