MEDICARE: ADRIANA MARTIN LCSW

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	101YM0800X	Mental Health Counselor	ASW72853	CA
2	390200000X	Student in an Organized Health Care Education/Training Program	F1115919	CA
3	1041C0700X	Clinical Social Worker	LCSW92927	CA

General Provider Information

NPI Number	:	1437529419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIANA MARTIN LCSW

Provider Business Mailing Address
First Line	:	1300 17TH ST
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93301-4504
Country	:	US
Telephone Number	:	661-852-5660
Fax Number	:	661-852-5694

Provider Business Practice Location Address
First Line	:	2951 CENTER ST
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93306-5303
Country	:	US
Telephone Number	:	661-631-3205
Fax Number	:

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

Provider Enumeration Date	:	10/02/2015
Last Update Date	:	08/12/2021

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