Healthcare Provider Details

I. General information

NPI: 1487665923
Provider Name (Legal Business Name): RICHARD ARRIOLA MARTINEZ LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 10/16/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 OAKDALE ROAD SUITE 1120 1317 OAKDALE ROAD SUITE 1120
MODESTO CA
95355-0001
US

IV. Provider business mailing address

1317 OAKDALE ROAD SUITE 1120
MODESTO CA
95355-0001
US

V. Phone/Fax

Practice location:
  • Phone: 209-573-7909
  • Fax: 209-526-1439
Mailing address:
  • Phone: 209-573-7909
  • Fax: 209-526-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14424
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14424
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: