Provider Demographics
NPI:1114229143
Name:TILLEY, MARTA LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARTA
Middle Name:LYNN
Last Name:TILLEY
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 1:10502 SATELLITE BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-8479
Mailing Address - Country:US
Mailing Address - Phone:407-850-9141
Mailing Address - Fax:407-850-9687
Practice Address - Street 1:10502 SATELLITE BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-8479
Practice Address - Country:US
Practice Address - Phone:407-850-9141
Practice Address - Fax:407-850-9687
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-24
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 32801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical