Healthcare Provider Details

I. General information

NPI: 1366642068
Provider Name (Legal Business Name): MICHELLE MARTINEZ TRAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE MARTINEZ ACSW

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 N CALIFORNIA ST
STOCKTON CA
95202-1552
US

IV. Provider business mailing address

1212 N CALIFORNIA ST
STOCKTON CA
95202-1552
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-8686
  • Fax: 209-468-2380
Mailing address:
  • Phone: 209-468-8686
  • Fax: 209-468-2380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number28796
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number81278
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: