Provider Demographics
NPI:1033250253
Name:ALBERT MARTINSON
Entity Type:Organization
Organization Name:ALBERT MARTINSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:PHELPS
Authorized Official - Last Name:MARTINSON
Authorized Official - Suffix:
Authorized Official - Credentials:ACSW LMSW
Authorized Official - Phone:231-598-0421
Mailing Address - Street 1:10431 ARTHUR RD
Mailing Address - Street 2:
Mailing Address - City:RODNEY
Mailing Address - State:MI
Mailing Address - Zip Code:49342-9780
Mailing Address - Country:US
Mailing Address - Phone:231-598-0421
Mailing Address - Fax:231-598-0421
Practice Address - Street 1:10431 ARTHUR RD
Practice Address - Street 2:
Practice Address - City:RODNEY
Practice Address - State:MI
Practice Address - Zip Code:49342-9780
Practice Address - Country:US
Practice Address - Phone:231-598-0421
Practice Address - Fax:231-598-0421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010635711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty