Provider Demographics
NPI:1053576439
Name:SCALA, MARTHA CLARK (MFT)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:CLARK
Last Name:SCALA
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 1:721 COLORADO AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-3972
Mailing Address - Country:US
Mailing Address - Phone:650-322-6430
Mailing Address - Fax:
Practice Address - Street 1:721 COLORADO AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-3972
Practice Address - Country:US
Practice Address - Phone:650-322-6430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC30222106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist