Provider Demographics
NPI:1013036672
Name:MARTINEZ, JOHN ANTHONY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ANTHONY
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6651A BALBOA BLVD
Mailing Address - Street 2:LAUSD SCHOOL MENTAL HEALTH CLINIC
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-5529
Mailing Address - Country:US
Mailing Address - Phone:818-997-2640
Mailing Address - Fax:
Practice Address - Street 1:6651A BALBOA BLVD
Practice Address - Street 2:LAUSD SCHOOL MENTAL HEALTH CLINIC
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-5529
Practice Address - Country:US
Practice Address - Phone:818-997-2640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 136831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical