Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 26577 | CA |
Y | 103TC0700X | Clinical Psychologist | 26577 | CA |
N | 225C00000X | Rehabilitation Counselor |
NPI | 1225345143 |
---|---|
Provider Name | Brooke A Martin |
First Address | Los Angeles, CA 90069-4702 |
Second Address | Culver City, CA 90230-4820 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2010 |
Last Update Date | 10/12/2014 |