Individual
KAITLYN MARIE MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3075 MYERS ST, RIVERSIDE, CA 92503-5525
(951) 358-6895
Mailing address
3075 MYERS ST, RIVERSIDE, CA 92503-5525
(951) 358-6895
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
104100000X
Social Worker
Primary
109101
CA
1041C0700X
Clinical Social Worker
109101
CA
106S00000X
Behavior Technician
—
—
Other
Enumeration date
08/18/2020
Last updated
09/12/2024
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