Healthcare Provider Details

I. General information

NPI: 1295238251
Provider Name (Legal Business Name): ESTHER MARTINO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2018
Last Update Date: 03/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 GRAYSON ST
BERKELEY CA
94710-2611
US

IV. Provider business mailing address

2745 MATHEWS ST
BERKELEY CA
94702-2244
US

V. Phone/Fax

Practice location:
  • Phone: 510-406-4166
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16545
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: