Provider Demographics
NPI:1073666913
Name:MARTHA DEMPSTER, LICSW, LLC
Entity Type:Organization
Organization Name:MARTHA DEMPSTER, LICSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMPSTER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:401-935-9784
Mailing Address - Street 1:1130 TEN ROD RD
Mailing Address - Street 2:SUITE D-104
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-4180
Mailing Address - Country:US
Mailing Address - Phone:401-935-9784
Mailing Address - Fax:401-295-5552
Practice Address - Street 1:1130 TEN ROD RD
Practice Address - Street 2:SUITE D-104
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-4180
Practice Address - Country:US
Practice Address - Phone:401-935-9784
Practice Address - Fax:401-295-5552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW01537251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI301257OtherBLUE CROSS BLUE SHIELD
RI1037150OtherNEIGHBORHOOD HEALTH PLAN
RI409249OtherBLUE CHIP