Provider Demographics
NPI:1255533220
Name:MARTIN, WYNETTA RENEE (LCSW)
Entity type:Individual
Prefix:
First Name:WYNETTA
Middle Name:RENEE
Last Name:MARTIN
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 1:8788 ELK GROVE BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-1767
Mailing Address - Country:US
Mailing Address - Phone:916-400-0505
Mailing Address - Fax:916-848-0511
Practice Address - Street 1:8788 ELK GROVE BLVD STE D
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-1767
Practice Address - Country:US
Practice Address - Phone:916-400-0505
Practice Address - Fax:916-848-0511
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS244091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical