Provider Demographics
NPI:1417090002
Name:MARTINEZ, MYRIAM MYRNA (MFT)
Entity Type:Individual
Prefix:MS
First Name:MYRIAM
Middle Name:MYRNA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7250 REDWOOD BOULEVAARD
Mailing Address - Street 2:SUITE 367
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-4025
Mailing Address - Country:US
Mailing Address - Phone:415-235-2734
Mailing Address - Fax:415-366-2117
Practice Address - Street 1:7250 REDWOOD BOULEVAARD
Practice Address - Street 2:SUITE 367
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-4025
Practice Address - Country:US
Practice Address - Phone:415-235-2734
Practice Address - Fax:415-366-2117
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47949106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist