Provider Demographics
NPI:1558632729
Name:MARTINEZ, PATRICIA E (MFT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:E
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 1:1137 2ND ST
Mailing Address - Street 2:213
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5011
Mailing Address - Country:US
Mailing Address - Phone:310-395-9390
Mailing Address - Fax:310-479-9149
Practice Address - Street 1:1137 2ND ST
Practice Address - Street 2:213
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5011
Practice Address - Country:US
Practice Address - Phone:310-395-9390
Practice Address - Fax:310-479-9149
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMT20050101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health