Provider Demographics
NPI:1073099388
Name:MARTIN, REBECCA (BSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7654 CATAWBA LN APT 4
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1873
Mailing Address - Country:US
Mailing Address - Phone:502-403-8206
Mailing Address - Fax:
Practice Address - Street 1:2250 THUNDERSTICK DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-9010
Practice Address - Country:US
Practice Address - Phone:859-739-0150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker