Provider Demographics
NPI:1518229731
Name:MARTIN, JENNIFER CHRISTINE (LMFT 113249)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CHRISTINE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMFT 113249
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3790 EL CAMINO REAL
Mailing Address - Street 2:#1045
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-3314
Mailing Address - Country:US
Mailing Address - Phone:650-332-8668
Mailing Address - Fax:
Practice Address - Street 1:3790 EL CAMINO REAL # 1045
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-3314
Practice Address - Country:US
Practice Address - Phone:650-332-8668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 106H00000X
CA113249106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor