Provider Demographics
NPI:1578815072
Name:DE ARMAS, MARTHA ROSE LOPEZ (LCSW)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:ROSE LOPEZ
Last Name:DE ARMAS
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:PO BOX 2027
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91778-2027
Mailing Address - Country:US
Mailing Address - Phone:323-317-4642
Mailing Address - Fax:
Practice Address - Street 1:153 JUNIPERO SERRA DR UNIT F
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1255
Practice Address - Country:US
Practice Address - Phone:323-317-4642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW989311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-2633765OtherMEDI-CAL