Provider Demographics
NPI:1306933734
Name:MARTINEZ, MERCEDES MARIA (MFT)
Entity type:Individual
Prefix:MS
First Name:MERCEDES
Middle Name:MARIA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 S BARRANCA AVE
Mailing Address - Street 2:SUITE L-107
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-2777
Mailing Address - Country:US
Mailing Address - Phone:626-332-4609
Mailing Address - Fax:909-396-5770
Practice Address - Street 1:599 S BARRANCA AVE
Practice Address - Street 2:SUITE L-107
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-2777
Practice Address - Country:US
Practice Address - Phone:626-332-4609
Practice Address - Fax:909-396-5770
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC23670101YA0400X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist