Healthcare Provider Details

I. General information

NPI: 1447449558
Provider Name (Legal Business Name): MARTHA JANE JOACHIM PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 10/13/2026
Certification Date: 10/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1795 BOXHEART DR UNIT 131
HEALDSBURG CA
95448-6402
US

IV. Provider business mailing address

1795 BOXHEART DR UNIT 131
HEALDSBURG CA
95448-6402
US

V. Phone/Fax

Practice location:
  • Phone: 310-477-0769
  • Fax: 310-390-9927
Mailing address:
  • Phone: 310-477-0769
  • Fax: 310-390-9927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY7032
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: