Provider Demographics
NPI:1972652899
Name:MARTIN, JANINE SIMONE
Entity Type:Individual
Prefix:MS
First Name:JANINE
Middle Name:SIMONE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5549 ALPINE RD
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-4029
Mailing Address - Country:US
Mailing Address - Phone:510-233-9217
Mailing Address - Fax:
Practice Address - Street 1:5549 ALPINE RD
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-4029
Practice Address - Country:US
Practice Address - Phone:510-233-9217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health