Healthcare Provider Details

I. General information

NPI: 1023365566
Provider Name (Legal Business Name): MARIA EDITH MARTINEZ MSW,ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA EDITH VARGAS MSW, ASW

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W BRIGGSMORE AVE STE I
MODESTO CA
95350-3839
US

IV. Provider business mailing address

2000 W BRIGGSMORE AVE STE I
MODESTO CA
95350-3839
US

V. Phone/Fax

Practice location:
  • Phone: 209-526-1476
  • Fax:
Mailing address:
  • Phone: 209-526-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number33477
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberASW84983
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: