Healthcare Provider Details

I. General information

NPI: 1801489331
Provider Name (Legal Business Name): BRENDA GUADALUPE MARTINEZ CHAVEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRENDA GUADALUPE MARTINEZ

II. Dates (important events)

Enumeration Date: 02/16/2021
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 SAINT DOMINICS DR STE 201
MANTECA CA
95337-7802
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 209-830-4062
  • Fax: 209-830-4077
Mailing address:
  • Phone: 800-470-0071
  • Fax: 916-854-6769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number129099
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW129099
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: