MEDICARE: MARTHA AGUILAR LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	LF61012010	WA
2	106H00000X	Marriage & Family Therapist	LMFT108963	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ918992Z	OTHER		SANTA CRUZ COUNTY MEDICARE GROUP PTAN#

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	PR-135977	OTHER	CA	ANTHEM

General Provider Information

NPI Number	:	1194849471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA AGUILAR LMFT

Provider Business Mailing Address
First Line	:	5608 17TH AVE NW STE 1516
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-5232
Country	:	US
Telephone Number	:	360-200-8788
Fax Number	:	888-809-1915

Provider Business Practice Location Address
First Line	:	5608 17TH AVENUE NW, SUITE 1516
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-5232
Country	:	US
Telephone Number	:	360-200-8788
Fax Number	:	888-809-1915

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	05/16/2022

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Directions to “ MARTHA AGUILAR LMFT” Practice Location

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