Provider Demographics
NPI:1437668886
Name:MARTINEZ, AMY CHRISTINA (LMFT129469)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:CHRISTINA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LMFT129469
Other - Prefix:MRS
Other - First Name:AMY
Other - Middle Name:CHRISTINA
Other - Last Name:MENDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1875 W REDONDO BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-3641
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1875 W REDONDO BEACH BLVD STE 303
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3644
Practice Address - Country:US
Practice Address - Phone:562-396-4844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103684101YM0800X, 106H00000X
CA129469106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA952633765OtherMEDI-CAL