Provider Demographics
NPI:1184836330
Name:MARTIN, JUNE MARIE (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:JUNE
Middle Name:MARIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S. EL CAMINO REAL
Mailing Address - Street 2:SUITE #3
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402
Mailing Address - Country:US
Mailing Address - Phone:650-703-9986
Mailing Address - Fax:650-712-8883
Practice Address - Street 1:1100 S. EL CAMINO REAL
Practice Address - Street 2:SUITE #3
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402
Practice Address - Country:US
Practice Address - Phone:650-348-4835
Practice Address - Fax:650-712-8883
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2012-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 22519103TC0700X
CA30679106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist