Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 62005 | TX |
NPI | 1003350414 |
---|---|
Provider Name | Ms. Melisa Dawn Martinez |
First Address | Amarillo, TEXAS 79109 |
Second Address | Amarillo, TX 79106-1990 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2016 |
Last Update Date | 05/12/2016 |