Healthcare Provider Details

I. General information

NPI: 1497241970
Provider Name (Legal Business Name): JAMIE LYNN MARTOS MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2018
Last Update Date: 02/21/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14891 AUTUMN LN
HELENDALE CA
92342-7721
US

IV. Provider business mailing address

PO BOX 3198
HELENDALE CA
92342-3198
US

V. Phone/Fax

Practice location:
  • Phone: 650-464-5437
  • Fax:
Mailing address:
  • Phone: 650-464-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2020034485
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102032
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: