Provider Demographics
NPI:1447934104
Name:MARTINEAU, MEGAN F (LCSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:F
Last Name:MARTINEAU
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E HIGHLAND AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-5484
Mailing Address - Country:US
Mailing Address - Phone:951-378-4543
Mailing Address - Fax:
Practice Address - Street 1:1200 E HIGHLAND AVE APT 102
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-5484
Practice Address - Country:US
Practice Address - Phone:951-378-4543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88987101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health