Healthcare Provider Details

I. General information

NPI: 1821185232
Provider Name (Legal Business Name): MARINA MARTIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10605 BALBOA BLVD STE 100
GRANADA HILLS CA
91344-6367
US

IV. Provider business mailing address

10605 BALBOA BLVD STE 100
GRANADA HILLS CA
91344-6367
US

V. Phone/Fax

Practice location:
  • Phone: 661-360-5631
  • Fax: 661-363-8951
Mailing address:
  • Phone: 661-360-5631
  • Fax: 661-363-8951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS21886
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: