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NPI Code Detail

MEDICARE: JAIMI S MARTIN LCSW, PMH-C

MEDICARE: JAIMI S MARTIN LCSW, PMH-C
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
1101YM0800XMental Health Counselor79676CA

General Provider Information

NPI Number : 1245460344
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAIMI S MARTIN LCSW, PMH-C
Provider Business Mailing Address
First Line : 1203 30TH ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92102-2303
Country : US
Telephone Number : 415-680-4587
Fax Number :
Provider Business Practice Location Address
First Line : 2911 ADAMS AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92116-1509
Country : US
Telephone Number : 619-786-1558
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2009
Last Update Date : 12/28/2019

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