Provider Demographics
NPI:1720218472
Name:VARRIAL, MARTIN MICHAEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:MICHAEL
Last Name:VARRIAL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 O ST
Mailing Address - Street 2:SUITE 261
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-6519
Mailing Address - Country:US
Mailing Address - Phone:916-718-0260
Mailing Address - Fax:
Practice Address - Street 1:2322 BUTANO DR
Practice Address - Street 2:SUITE 211
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-0629
Practice Address - Country:US
Practice Address - Phone:916-718-0260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 22144103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical