Provider Demographics
NPI:1578691739
Name:MARTINEZ-MUELLER, JESSICA CLARIVEL (CATC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:CLARIVEL
Last Name:MARTINEZ-MUELLER
Suffix:
Gender:F
Credentials:CATC
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:CLARIVEL
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:459 BADEN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-4626
Mailing Address - Country:US
Mailing Address - Phone:209-204-3291
Mailing Address - Fax:
Practice Address - Street 1:810 CAPP ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3225
Practice Address - Country:US
Practice Address - Phone:415-285-0810
Practice Address - Fax:415-285-0810
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health