Provider Demographics
NPI:1821560202
Name:MARTINEZ-HANNON, MERCEDES R (AMFT)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:R
Last Name:MARTINEZ-HANNON
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 1:3030 E COLORADO BLVD # 214
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3840
Mailing Address - Country:US
Mailing Address - Phone:909-493-5332
Mailing Address - Fax:
Practice Address - Street 1:3030 E COLORADO BLVD # 214
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3840
Practice Address - Country:US
Practice Address - Phone:909-493-5332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-21
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT127300106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist