Provider Demographics
NPI:1710640164
Name:GARCIA, MARIANNA MARTINEZ (AMFT)
Entity Type:Individual
Prefix:
First Name:MARIANNA
Middle Name:MARTINEZ
Last Name:GARCIA
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4420 N FIRST ST SUITE 110
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726
Mailing Address - Country:US
Mailing Address - Phone:559-225-1102
Mailing Address - Fax:
Practice Address - Street 1:4420 N FIRST ST SUITE 110
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726
Practice Address - Country:US
Practice Address - Phone:559-225-1102
Practice Address - Fax:559-375-7164
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT127301106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA171M00000XMedicaid