Provider Demographics
NPI:1144459280
Name:MARTINEZ, PEGGY ANN (LCSW)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:ANN
Last Name:MARTINEZ
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 60582
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95860-0582
Mailing Address - Country:US
Mailing Address - Phone:916-812-7127
Mailing Address - Fax:916-488-6018
Practice Address - Street 1:8421 AUBURN BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-0359
Practice Address - Country:US
Practice Address - Phone:916-812-7127
Practice Address - Fax:916-483-6176
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-10
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 14541101YM0800X, 1041C0700X
CAPPS 090095587101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool