Provider Demographics
NPI:1073153714
Name:MARTINEZ, JENNIFER LYNN (APCC, AMFT)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:LYNN
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:APCC, AMFT
Other - Prefix:MISS
Other - First Name:JENIFER
Other - Middle Name:LYNN
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AMFT, APCC
Mailing Address - Street 1:3517 CAMINO DEL RIO S STE 407
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4028
Mailing Address - Country:US
Mailing Address - Phone:619-955-8905
Mailing Address - Fax:
Practice Address - Street 1:3517 CAMINO DEL RIO S STE 407
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4028
Practice Address - Country:US
Practice Address - Phone:619-955-8905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA116717101Y00000X
CAAMFT116717106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherOTHER