Provider Demographics
NPI:1083760243
Name:MARTIN, ROBERTA LYNN (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:LYNN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 E WEST HWY
Mailing Address - Street 2:SUITE 26
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4524
Mailing Address - Country:US
Mailing Address - Phone:301-908-8110
Mailing Address - Fax:
Practice Address - Street 1:4400 E WEST HWY
Practice Address - Street 2:SUITE 26
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4524
Practice Address - Country:US
Practice Address - Phone:301-908-8110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0830101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral