Provider Demographics
NPI:1972314169
Name:MARTINEZ, ALYSSA ANN (LMFT)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ANN
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 PROFESSIONAL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-7781
Mailing Address - Country:US
Mailing Address - Phone:916-835-8818
Mailing Address - Fax:
Practice Address - Street 1:2330 PROFESSIONAL DR STE 100
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-7781
Practice Address - Country:US
Practice Address - Phone:916-835-8818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA150518106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist