Provider Demographics
NPI:1316269483
Name:RANNEY, MARTHA JEAN (PHD, LCSW)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:JEAN
Last Name:RANNEY
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6475 E PACIFIC COAST HWY
Mailing Address - Street 2:PMB #353
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-4201
Mailing Address - Country:US
Mailing Address - Phone:562-754-7606
Mailing Address - Fax:
Practice Address - Street 1:6475 E PACIFIC COAST HWY
Practice Address - Street 2:PMB #353
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4201
Practice Address - Country:US
Practice Address - Phone:562-754-7606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS190741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEPS012940Medicaid
CASW19074Medicare PIN