Provider Demographics
NPI:1700072782
Name:MARTINEZ, CONNIE LYNN (PSYD LCSW)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:LYNN
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PSYD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 ROCKMONT CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-1504
Mailing Address - Country:US
Mailing Address - Phone:916-895-0125
Mailing Address - Fax:
Practice Address - Street 1:190 ROCKMONT CIR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95835-1504
Practice Address - Country:US
Practice Address - Phone:916-895-0125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA852921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical