Provider Demographics
NPI:1144254566
Name:RADETSKY, MARTHA (MFT)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:RADETSKY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SYLVIA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3143
Mailing Address - Country:US
Mailing Address - Phone:415-246-0400
Mailing Address - Fax:
Practice Address - Street 1:2400 LAS GALLINAS AVE STE 135
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-1452
Practice Address - Country:US
Practice Address - Phone:415-246-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 36377106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist