Provider Demographics
NPI:1255363859
Name:KUTNIK, MARTI LINDA (LCSW, MFT)
Entity type:Individual
Prefix:MS
First Name:MARTI
Middle Name:LINDA
Last Name:KUTNIK
Suffix:
Gender:F
Credentials:LCSW, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 N GRANADOS AVE
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1221
Mailing Address - Country:US
Mailing Address - Phone:858-481-7974
Mailing Address - Fax:858-481-7975
Practice Address - Street 1:780 N GRANADOS AVE
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1221
Practice Address - Country:US
Practice Address - Phone:858-481-7974
Practice Address - Fax:858-481-7975
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS130931041C0700X
CAMFC8513106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist