Provider Demographics
NPI:1083891626
Name:MARTIN, DEBORAH ANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:ANNE
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 1:2252 S BOLTON AVE
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34448-2206
Mailing Address - Country:US
Mailing Address - Phone:352-804-2953
Mailing Address - Fax:352-228-8901
Practice Address - Street 1:116 NE 5TH ST
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429
Practice Address - Country:US
Practice Address - Phone:352-804-2953
Practice Address - Fax:352-228-8901
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104100000X
FLSW83751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008618700Medicaid
FL002272900Medicaid