Debra A. Martinez, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2155-C Issued in AR

Practice address

1615 MLK Blvd
Malvern, AR 72104

Phone

(501) 332-5236

Fax

(501) 620-5109

NPI assigned

Jan 23, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1201046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528934400000",
    "number": "1629255476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 WELLNESS WAY",
            "city": "HOT SPRINGS",
            "state": "AR",
            "postal_code": "719136478",
            "telephone_number": "501-624-7111",
            "fax_number": "501-620-5109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 MLK BLVD",
            "city": "MALVERN",
            "state": "AR",
            "postal_code": "72104",
            "telephone_number": "501-332-5236",
            "fax_number": "501-620-5109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINEZ",
        "first_name": "DEBRA",
        "middle_name": "A.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-23",
        "last_updated": "2018-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AR",
            "license": "2155-C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "170706795",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Malvern Physical Therapy and Wellness
• Malvern Public School District
• Malvern SNF Operations LLC
• Kerri Martin
• Laken Martin
• Mary'S Medico Rental & Sales, Inc.
• Chelsie Mason
• Stacy Elaine Mattox, OTR
• Maxus
• Terri Mays

• Clinical Social Worker in Malvern, AR
• Providers in Malvern, AR by specialty
• Clinical Social Worker in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.