Provider Demographics
NPI:1346398641
Name:HENDRICKS, MARTHA JEAN (PHD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:JEAN
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 ARTESIA BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-7158
Mailing Address - Country:US
Mailing Address - Phone:310-374-5825
Mailing Address - Fax:
Practice Address - Street 1:1721 ARTESIA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-7158
Practice Address - Country:US
Practice Address - Phone:310-374-5825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10337103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical