Provider Demographics
NPI:1003959263
Name:MARTIN, KIMBERLY SUSAN (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:SUSAN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 ROUTE 9
Mailing Address - Street 2:SUITE G
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065
Mailing Address - Country:US
Mailing Address - Phone:518-598-3192
Mailing Address - Fax:888-495-2213
Practice Address - Street 1:1745 ROUTE 9
Practice Address - Street 2:SUITE G
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065
Practice Address - Country:US
Practice Address - Phone:518-598-3192
Practice Address - Fax:888-495-2213
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0504051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical