Provider Demographics
NPI:1245460344
Name:MARTIN, JAIMI S (LCSW, PMH-C)
Entity type:Individual
Prefix:
First Name:JAIMI
Middle Name:S
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSW, PMH-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 30TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-2303
Mailing Address - Country:US
Mailing Address - Phone:415-680-4587
Mailing Address - Fax:
Practice Address - Street 1:2911 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-1509
Practice Address - Country:US
Practice Address - Phone:619-786-1558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2019-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79676101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health