Provider Demographics
NPI:1174165617
Name:MARTINO, AMANDA (APCC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MARTINO
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 HOMESTEAD RD STE 220
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-5485
Mailing Address - Country:US
Mailing Address - Phone:833-256-4225
Mailing Address - Fax:800-660-9443
Practice Address - Street 1:1171 HOMESTEAD RD STE 220
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-5485
Practice Address - Country:US
Practice Address - Phone:833-256-4225
Practice Address - Fax:800-660-9443
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7124101YM0800X
CA117067106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health