Provider Demographics
NPI:1578780334
Name:FIERRO, MARTIN ANTHONY (LMFT)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:ANTHONY
Last Name:FIERRO
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6731 FIVE STAR BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-2680
Mailing Address - Country:US
Mailing Address - Phone:916-630-0300
Mailing Address - Fax:
Practice Address - Street 1:6731 FIVE STAR BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2680
Practice Address - Country:US
Practice Address - Phone:916-630-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38554106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9949Medicaid