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General NPI Number Information
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NPI Number | 1942822366
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Entity Type | Individual
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Provider Name | CARMEN REGINA MARTINES MA
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Gender | Female
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Dates
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Enumeration Date | 05/07/2020
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Last Update Date | 05/28/2020
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Provider Practice Location Address
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Address Line | 3150 18TH ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94110-2074
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Country | US
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Telephone | 650-516-7107
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Fax |
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Provider Business Mailing Address
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Address Line | 719 48TH AVE
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City | SAN FRANCISCO
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State | CA
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Zip | 94121-3209
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Country | US
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Telephone | 608-217-1689
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 107280
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | 107280
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License Number State | CA
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