Provider Demographics
NPI:1992247324
Name:MARTIN, DEANNA (LMFT)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:MARTIN
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 1:141 MOZART AVE
Mailing Address - Street 2:
Mailing Address - City:CARDIFF BY THE SEA
Mailing Address - State:CA
Mailing Address - Zip Code:92007-2339
Mailing Address - Country:US
Mailing Address - Phone:760-612-3768
Mailing Address - Fax:
Practice Address - Street 1:4405 MANCHESTER AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4940
Practice Address - Country:US
Practice Address - Phone:760-612-3768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91283106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist