Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker |
NPI | 1003169640 |
---|---|
Provider Name | Ashley Martinez |
First Address | Westfield, MA 01085-4598 |
Second Address | Westfield, MA 01085-4598 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2012 |
Last Update Date | 19/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1300881 | (05) | MA |