Provider Demographics
NPI:1528249836
Name:MARTI, STEPHANIE JILLAINE (PSYD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:JILLAINE
Last Name:MARTI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 SIR FRANCIS DRAKE BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1440
Mailing Address - Country:US
Mailing Address - Phone:415-209-8804
Mailing Address - Fax:
Practice Address - Street 1:1036 SIR FRANCIS DRAKE BLVD STE 203
Practice Address - Street 2:
Practice Address - City:KENTFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904-1440
Practice Address - Country:US
Practice Address - Phone:415-209-8804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26159103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist