Provider Demographics
NPI:1356549059
Name:MARTINEZ, JENNIFER L (MS)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 THARP RD STE J
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-2648
Mailing Address - Country:US
Mailing Address - Phone:530-674-7770
Mailing Address - Fax:530-674-5240
Practice Address - Street 1:1245 THARP RD STE J
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-2648
Practice Address - Country:US
Practice Address - Phone:530-674-7770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC45569106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist