Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) |
NPI | 1518294453 |
---|---|
Provider Name | Rafael Martinez JR. |
First Address | New York, NY 10003-3304 |
Second Address | New York, NY 10003-3304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2009 |
Last Update Date | 13/11/2009 |