Provider Demographics
NPI:1194849471
Name:AGUILAR, MARTHA (LMFT)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5608 17TH AVE NW STE 1516
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-5232
Mailing Address - Country:US
Mailing Address - Phone:360-200-8788
Mailing Address - Fax:888-809-1915
Practice Address - Street 1:5608 17TH AVENUE NW, SUITE 1516
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-5232
Practice Address - Country:US
Practice Address - Phone:360-200-8788
Practice Address - Fax:888-809-1915
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF61012010106H00000X
CALMFT108963106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ918992ZOtherSANTA CRUZ COUNTY MEDICARE GROUP PTAN#
CAPR-135977OtherANTHEM