Provider Demographics
NPI:1922163658
Name:MARTINEZ, JOHN MANUEL (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MANUEL
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 BERNAL RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1343
Mailing Address - Country:US
Mailing Address - Phone:408-972-3099
Mailing Address - Fax:408-972-6494
Practice Address - Street 1:175 BERNAL RD
Practice Address - Street 2:SUITE 140
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1343
Practice Address - Country:US
Practice Address - Phone:408-972-3099
Practice Address - Fax:408-972-6494
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS101911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical