Provider Demographics
NPI:1164636197
Name:MARTIN, SYLVIA ROCHELLE (MFT)
Entity Type:Individual
Prefix:MS
First Name:SYLVIA
Middle Name:ROCHELLE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14156 MAGNOLIA BLVD
Mailing Address - Street 2:105
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-1181
Mailing Address - Country:US
Mailing Address - Phone:323-654-7262
Mailing Address - Fax:
Practice Address - Street 1:14156 MAGNOLIA BLVD
Practice Address - Street 2:105
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-1181
Practice Address - Country:US
Practice Address - Phone:323-654-7262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 22336106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist