Provider Demographics
NPI:1659907038
Name:MARTINEZ, BIANCA NICOLE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:BIANCA
Middle Name:NICOLE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14711 PRINCETON AVE STE 503
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-1457
Mailing Address - Country:US
Mailing Address - Phone:626-344-0552
Mailing Address - Fax:626-550-4727
Practice Address - Street 1:14448 E AMHERST ST
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-1302
Practice Address - Country:US
Practice Address - Phone:626-344-0552
Practice Address - Fax:626-550-4727
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA118745106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist