Provider Demographics
NPI:1770695165
Name:MARTINUSEN, JINNIE DEANNE (MFT)
Entity type:Individual
Prefix:MRS
First Name:JINNIE
Middle Name:DEANNE
Last Name:MARTINUSEN
Suffix:
Gender:
Credentials:MFT
Other - Prefix:MRS
Other - First Name:JINNIE
Other - Middle Name:DEANNE
Other - Last Name:WONG-MARTINUSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:P.O. BOX 188412
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818
Mailing Address - Country:US
Mailing Address - Phone:916-838-2236
Mailing Address - Fax:916-929-2246
Practice Address - Street 1:2627 CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5904
Practice Address - Country:US
Practice Address - Phone:916-838-2236
Practice Address - Fax:916-244-0574
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA413808MFTINTERN106H00000X
CA43514106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist