Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 1041C0700X | Clinical Social Worker | 64456 | CA |
NPI | 1003140211 |
---|---|
Provider Name | Mrs. Bernice Martinez |
First Address | Los Angeles, CA 90020-1912 |
Second Address | Pomona, CA 91766-1608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2009 |
Last Update Date | 24/03/2021 |