Provider Demographics
NPI:1568589216
Name:MARTIN, SHEILA M (MFT)
Entity Type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:M
Last Name:MARTIN
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 1:7011 MADDEN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-5127
Mailing Address - Country:US
Mailing Address - Phone:323-752-2842
Mailing Address - Fax:
Practice Address - Street 1:3126 GLENROSE AVE
Practice Address - Street 2:#210
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-4328
Practice Address - Country:US
Practice Address - Phone:626-396-5955
Practice Address - Fax:626-296-9818
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49243106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist