| Healing Blue Inc A Licensed Clinical Social Worker Coporation | |
|
10315 Woodley Ave Ste 215 Granada Hills CA 91344-6950 | |
| (818) 945-9075 | |
| Not Available |
| Full Name | Healing Blue Inc A Licensed Clinical Social Worker Coporation |
|---|---|
| Speciality | Social Worker |
| Location | 10315 Woodley Ave Ste 215, Granada Hills, California |
| Authorized Official Name and Position | Maria Martinez (OWNER) |
| Authorized Official Contact | 3233513633 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Healing Blue Inc A Licensed Clinical Social Worker Coporation 16001 Horace St Granada Hills CA 91344-5322 Ph: (323) 351-3633 | Healing Blue Inc A Licensed Clinical Social Worker Coporation 10315 Woodley Ave Ste 215 Granada Hills CA 91344-6950 Ph: (818) 945-9075 |
| NPI Number | 1457840258 |
|---|---|
| Provider Enumeration Date | 05/07/2018 |
| Last Update Date | 03/16/2023 |
| Certification Date | 12/22/2022 |
| Medicare PECOS PAC ID | 7911249420 |
|---|---|
| Medicare Enrollment ID | O20190502003126 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457840258 | NPI | - | NPPES |
| 80703 | Other | CA | LCSW LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | LCSW80703 (California) | Primary |
| Provider Name | Maria G Martinez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235636473 PECOS PAC ID: 4688918527 Enrollment ID: I20200521000422 |
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