Provider Demographics
NPI:1134175003
Name:MARTINEZ-BARRAZA, LORI DIANE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:DIANE
Last Name:MARTINEZ-BARRAZA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 LOS OSOS VALLEY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-3206
Mailing Address - Country:US
Mailing Address - Phone:805-534-9373
Mailing Address - Fax:805-534-9373
Practice Address - Street 1:900 LOS OSOS VALLEY RD
Practice Address - Street 2:SUITE C
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-3206
Practice Address - Country:US
Practice Address - Phone:805-534-9373
Practice Address - Fax:805-534-9373
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39556106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist