Provider Demographics
NPI:1184282998
Name:MARTINEZ, LIZETTE GABRIELA (LCSW)
Entity type:Individual
Prefix:
First Name:LIZETTE
Middle Name:GABRIELA
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:PO BOX 276950
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-6950
Mailing Address - Country:US
Mailing Address - Phone:415-600-3503
Mailing Address - Fax:415-369-1382
Practice Address - Street 1:2300 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2753
Practice Address - Country:US
Practice Address - Phone:415-600-3503
Practice Address - Fax:415-369-1382
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1189601041C0700X, 1041C0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program