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General NPI Number Information
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NPI Number | 1992247324
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Entity Type | Individual
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Provider Name | DEANNA MARTIN LMFT
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Gender | Female
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Dates
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Enumeration Date | 11/16/2016
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Last Update Date | 11/16/2016
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Provider Practice Location Address
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Address Line | 4405 MANCHESTER AVE SUITE 108
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City | ENCINITAS
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State | CA
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Zip | 92024-4940
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Country | US
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Telephone | 760-612-3768
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Fax |
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Provider Business Mailing Address
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Address Line | 141 MOZART AVE
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City | CARDIFF BY THE SEA
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State | CA
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Zip | 92007-2339
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Country | US
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Telephone | 760-612-3768
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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 | 91283
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License Number State | CA
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