Provider Demographics
NPI:1154521433
Name:LAPLACA, MARTIN B (LCSW)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:B
Last Name:LAPLACA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 WINDSOR AVE
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:94708-1041
Mailing Address - Country:US
Mailing Address - Phone:510-644-0666
Mailing Address - Fax:
Practice Address - Street 1:286 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-3610
Practice Address - Country:US
Practice Address - Phone:619-859-6270
Practice Address - Fax:619-527-8536
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW26211101YM0800X
CA262111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health