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NPI Code Detail

MEDICARE: MS. MARI LACRESSA MARTIN L.C.S.W.

MEDICARE: MS. MARI LACRESSA MARTIN L.C.S.W.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker14027CA

General Provider Information

NPI Number : 1023142957
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARI LACRESSA MARTIN L.C.S.W.
Provider Business Mailing Address
First Line : 2486 CASITAS AVE
Second Line :
City : ALTADENA
State : CA
Zip : 91001-5271
Country : US
Telephone Number : 626-794-1860
Fax Number : 626-794-1860
Provider Business Practice Location Address
First Line : 1520 N RAYMOND AVE BLDG 2-7
Second Line :
City : PASADENA
State : CA
Zip : 91103-1819
Country : US
Telephone Number : 626-396-5920
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2007
Last Update Date : 03/12/2021

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