Provider Demographics
NPI:1215252804
Name:MARTIN, NAOMI COOPER (MFT)
Entity type:Individual
Prefix:MRS
First Name:NAOMI
Middle Name:COOPER
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MISS
Other - First Name:NAOMI
Other - Middle Name:LYNN
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2111 S EL CAMINO REAL STE 300
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-9000
Mailing Address - Country:US
Mailing Address - Phone:760-717-9405
Mailing Address - Fax:408-419-1852
Practice Address - Street 1:2424 WEST VISTA WAY,
Practice Address - Street 2:SUITE 105
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054
Practice Address - Country:US
Practice Address - Phone:760-716-3268
Practice Address - Fax:760-439-1124
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48304106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist