Healthcare Provider Details

I. General information

NPI: 1184282998
Provider Name (Legal Business Name): LIZETTE GABRIELA MARTINEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 CALIFORNIA ST
SAN FRANCISCO CA
94115-2753
US

IV. Provider business mailing address

PO BOX 276950
SACRAMENTO CA
95827-6950
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-3503
  • Fax: 415-369-1382
Mailing address:
  • Phone: 415-600-3503
  • Fax: 415-369-1382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number118960
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: