Individual provider Active NPI

Mary Martinez, LCSW

  • Clinical Social Worker
  • Phoenix, AZ
National Provider Identifier
1740924679
Registry record updated Oct 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW-21411 Issued in AZ
Practice address
750 E Thunderbird Rd # 1-3
Phoenix, AZ 85022-5306
Phone
(602) 230-7373
Fax
(602) 218-6383
NPI assigned
Apr 26, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LCSW-21411 AZ Primary
Social Worker 104100000X LMSW-13318 AZ

Addresses

Primary practice location

750 E Thunderbird Rd # 1-3
Phoenix, AZ 85022-5306

Mailing address

3101 N Central Ave Ste 550
Phoenix, AZ 85012-2635
Phone (602) 230-7373

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230606002584 AZ Practitioner - Clinical Social Worker 4486011434 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Denova Collaborative Health, LLCGroup PAC ID 2466437736, 141 clinicians

Practice addresses (Care Compare)

750 E Thunderbird Rd
1 3
Phoenix, AZ 85022-5306
Phone (602) 230-7373

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LMSW-13318AZMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Denova Collaborative Health, LLC Current Accepting new patients
Denova Collaborative Health, LLC CurrentSince Apr 19, 2023 Accepting new patients

Locations

2204 S Dobson Rd
Ste 201
Mesa, AZ 85202
Phone (602) 374-4410

2204 S Dobson Rd
Ste 102
Mesa, AZ 85202

750 E Thunderbird Rd
#13
Phoenix, AZ 85022

3033 N Central Ave
Ste 700
Phoenix, AZ 85012
Phone (602) 281-7289

3620 N 3rd St
Phoenix, AZ 85012
Phone (602) 329-8250

3101 N Central Ave
Ste 500
Phoenix, AZ 85012

750 E Thunderbird Rd
Ste 13
Phoenix, AZ 85022
Phone (602) 682-7455

3101 N Central Ave
Ste 550
Phoenix, AZ 85012

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1650931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697673600000",
    "number": "1740924679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3101 N CENTRAL AVE STE 550",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122635",
            "telephone_number": "602-230-7373",
            "fax_number": "602-682-7455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 E THUNDERBIRD RD # 1-3",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850225306",
            "telephone_number": "602-230-7373",
            "fax_number": "602-218-6383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINEZ",
        "first_name": "MARY",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-26",
        "last_updated": "2023-10-19",
        "certification_date": "2023-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AZ",
            "license": "LCSW-21411",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "AZ",
            "license": "LMSW-13318",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.