Provider Demographics
NPI:1164878179
Name:MARTIN, ANDREW (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 SE 6TH ST STE 110E
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-1215
Mailing Address - Country:US
Mailing Address - Phone:812-437-0121
Mailing Address - Fax:812-437-0006
Practice Address - Street 1:401 SE 6TH ST STE 110E
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1215
Practice Address - Country:US
Practice Address - Phone:812-437-0121
Practice Address - Fax:812-437-0006
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-09
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
IN34007087A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical