Provider Demographics
NPI:1457478232
Name:MARTENSON, LUANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LUANN
Middle Name:
Last Name:MARTENSON
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 1:73 W SIERRA MADRE BLVD
Mailing Address - Street 2:ST. 203
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-2462
Mailing Address - Country:US
Mailing Address - Phone:626-737-0390
Mailing Address - Fax:626-798-8655
Practice Address - Street 1:73 W SIERRA MADRE BLVD
Practice Address - Street 2:ST. 203
Practice Address - City:SIERRA MADRE
Practice Address - State:CA
Practice Address - Zip Code:91024-2462
Practice Address - Country:US
Practice Address - Phone:626-737-0390
Practice Address - Fax:626-798-8655
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12092103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical