Provider Demographics
NPI:1962017103
Name:MARTINEZ, SOFIA CELESTINA (LCSW)
Entity Type:Individual
Prefix:
First Name:SOFIA
Middle Name:CELESTINA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 ADLENA DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-2349
Mailing Address - Country:US
Mailing Address - Phone:714-680-6060
Mailing Address - Fax:
Practice Address - Street 1:835 ADLENA DR
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-2349
Practice Address - Country:US
Practice Address - Phone:714-722-4712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW951871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical