Provider Demographics
NPI:1124379904
Name:MARTIN, LORRIE ANNE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:LORRIE
Middle Name:ANNE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5957 US ROUTE 20
Mailing Address - Street 2:
Mailing Address - City:LA FAYETTE
Mailing Address - State:NY
Mailing Address - Zip Code:13084-9701
Mailing Address - Country:US
Mailing Address - Phone:315-677-3152
Mailing Address - Fax:315-677-3154
Practice Address - Street 1:5957 US ROUTE 20
Practice Address - Street 2:
Practice Address - City:LA FAYETTE
Practice Address - State:NY
Practice Address - Zip Code:13084-9701
Practice Address - Country:US
Practice Address - Phone:315-677-3152
Practice Address - Fax:315-677-3154
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0688411041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool