Provider Demographics
NPI:1003968140
Name:MARTELL, CLAIRE ELIZABETH (MSW LCSW)
Entity Type:Individual
Prefix:MS
First Name:CLAIRE
Middle Name:ELIZABETH
Last Name:MARTELL
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Gender:F
Credentials:MSW LCSW
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Mailing Address - Street 1:23 TECHNOLOGY DRIVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-0000
Mailing Address - Country:US
Mailing Address - Phone:631-689-2617
Mailing Address - Fax:631-736-1442
Practice Address - Street 1:1239 ROUTE 25A
Practice Address - Street 2:N COUNTRY ROAD SUITE 6A
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-1934
Practice Address - Country:US
Practice Address - Phone:631-689-2617
Practice Address - Fax:631-736-1442
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2019-10-14
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Provider Licenses
StateLicense IDTaxonomies
NYR04022311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN8K561Medicare ID - Type Unspecified