Provider Demographics
NPI:1124438460
Name:MARTINEZ, PRISMA (MS, LMFT)
Entity type:Individual
Prefix:
First Name:PRISMA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1716
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93062-1716
Mailing Address - Country:US
Mailing Address - Phone:818-743-6517
Mailing Address - Fax:818-626-5056
Practice Address - Street 1:1720 E LOS ANGELES AVE STE 237
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-5829
Practice Address - Country:US
Practice Address - Phone:818-743-6517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111896106H00000X
225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist