1205277589 NPI number — MS. JULIETA I MACIAS-MARTINEZ LCSW-C, PH.D.

Table of content: MS. JULIETA I MACIAS-MARTINEZ LCSW-C, PH.D. (NPI 1205277589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205277589 NPI number — MS. JULIETA I MACIAS-MARTINEZ LCSW-C, PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACIAS-MARTINEZ
Provider First Name:
JULIETA
Provider Middle Name:
I
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW-C, PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MACIAS
Provider Other First Name:
JULIETA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW-C, PH.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1205277589
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800
Provider Second Line Business Mailing Address:
S FREDERICK AVE. SUITE 200A
Provider Business Mailing Address City Name:
GAITHERSBURG
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20877
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-380-7901
Provider Business Mailing Address Fax Number:
240-235-7015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800
Provider Second Line Business Practice Location Address:
S FREDERICK AVE. SUITE 200A
Provider Business Practice Location Address City Name:
GAITHERSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20877
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-380-7901
Provider Business Practice Location Address Fax Number:
240-235-7015
Provider Enumeration Date:
07/15/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  16574 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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