Provider Demographics
NPI:1982300901
Name:MARTINEZ, MARY DOROTHY (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:DOROTHY
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:DOROTHY
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:984 GAYLON WAY
Mailing Address - Street 2:
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-2180
Mailing Address - Country:US
Mailing Address - Phone:505-589-8387
Mailing Address - Fax:
Practice Address - Street 1:4660 MACK RD STE 168
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-8202
Practice Address - Country:US
Practice Address - Phone:916-422-2954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1119821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty