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Provider Information for 1508344714


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PATRICIA MARRAINE MARTIN LMFT


Sex: Female

NPI: 1508344714
Last Updated: 2021-02-26
Certification Date: 2021-02-26

Details

NameValue
NPI1508344714
Enumeration Date2018-07-31
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address PO BOX 1054
MIRA LOMA, CA 91752-8054
United States

Phone: 951-893-8129 | Fax:
 
Primary Practice Address 1625 14TH ST
RIVERSIDE, CA 92503
United States

Phone: 951-955-1560 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YM0800X - Counselor - Mental HealthCA118287