Provider Demographics
NPI:1043406630
Name:MARTINEZ, ELIZARAHY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELIZARAHY
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
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:P.O. BOX 492
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-0049
Mailing Address - Country:US
Mailing Address - Phone:510-483-3030
Mailing Address - Fax:510-483-4277
Practice Address - Street 1:1545 WEBSTER ST
Practice Address - Street 2:SUITE A
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4917
Practice Address - Country:US
Practice Address - Phone:707-418-0209
Practice Address - Fax:510-483-4277
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW658131041C0700X
247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other