Provider Demographics
NPI:1184472946
Name:MARTHA, SANDRA MELANY (LCSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:MELANY
Last Name:MARTHA
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 1:1600 PALM AVE SPC 95
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-1024
Mailing Address - Country:US
Mailing Address - Phone:619-207-6535
Mailing Address - Fax:
Practice Address - Street 1:3824 PENDIENTE CT APT 201
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-3709
Practice Address - Country:US
Practice Address - Phone:619-207-6535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2500430021041S0200X
CA1205441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool