Provider Demographics
NPI:1841213394
Name:MARTINEZ, CHANTEL PALENKO (MFT)
Entity Type:Individual
Prefix:MRS
First Name:CHANTEL
Middle Name:PALENKO
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5126 ALDER
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2301
Mailing Address - Country:US
Mailing Address - Phone:949-285-1271
Mailing Address - Fax:
Practice Address - Street 1:5126 ALDER
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2301
Practice Address - Country:US
Practice Address - Phone:949-285-1271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41156106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist