Provider Demographics
NPI:1073784435
Name:MARTIN, SARAH ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:ELIZABETH
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7037 N WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-5137
Mailing Address - Country:US
Mailing Address - Phone:503-449-2094
Mailing Address - Fax:
Practice Address - Street 1:1130 SW MORRISON ST
Practice Address - Street 2:SUITE 619
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2234
Practice Address - Country:US
Practice Address - Phone:503-473-0108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL61531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical