Provider Demographics
NPI:1386412104
Name:BIANCA N. MARTINEZ, LICENSED MARRIAGE AND FAMILY THERAPIST, INC.
Entity type:Organization
Organization Name:BIANCA N. MARTINEZ, LICENSED MARRIAGE AND FAMILY THERAPIST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER/THERAPIST/SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BIANCA
Authorized Official - Middle Name:N
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:626-344-0552
Mailing Address - Street 1:14711 PRINCETON AVE STE 5-503
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-1457
Mailing Address - Country:US
Mailing Address - Phone:626-344-0552
Mailing Address - Fax:626-550-4727
Practice Address - Street 1:14448 E AMHERST ST
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-1302
Practice Address - Country:US
Practice Address - Phone:626-344-0552
Practice Address - Fax:626-550-4727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty