Provider Demographics
NPI:1336687789
Name:MARTIN-JOSEPHS, DENA LYNN (ADDICTION COUNSELOR)
Entity Type:Individual
Prefix:MRS
First Name:DENA
Middle Name:LYNN
Last Name:MARTIN-JOSEPHS
Suffix:
Gender:F
Credentials:ADDICTION COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1310
Mailing Address - Country:US
Mailing Address - Phone:415-717-9892
Mailing Address - Fax:
Practice Address - Street 1:125 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-1310
Practice Address - Country:US
Practice Address - Phone:415-717-9892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARI-M1302200046101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)