Provider Demographics
NPI:1447036942
Name:RENAUX MARTINEZ, CRISTA (LICSW)
Entity type:Individual
Prefix:MRS
First Name:CRISTA
Middle Name:
Last Name:RENAUX MARTINEZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 ASSISI DR NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-1637
Mailing Address - Country:US
Mailing Address - Phone:507-218-3466
Mailing Address - Fax:
Practice Address - Street 1:1530 ASSISI DR NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-1637
Practice Address - Country:US
Practice Address - Phone:507-218-3466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN309231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical