Provider Demographics
NPI:1295864932
Name:CONTRERAS-PANTOJA, MARTHA ROSE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:ROSE
Last Name:CONTRERAS-PANTOJA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:MARTHA
Other - Middle Name:ROSE
Other - Last Name:CONTRERAS-PANTOJA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1151 DOVE ST STE 295
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2843
Mailing Address - Country:US
Mailing Address - Phone:949-525-8056
Mailing Address - Fax:
Practice Address - Street 1:1151 DOVE ST STE 295
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-525-8056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 253651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical