Provider Demographics
NPI:1174656433
Name:MARTIN, DOROTHY I (LCSW)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:I
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 1:165 N SIERRA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-3840
Mailing Address - Country:US
Mailing Address - Phone:520-405-8228
Mailing Address - Fax:
Practice Address - Street 1:800 N SWAN RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1262
Practice Address - Country:US
Practice Address - Phone:520-405-8228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW10831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZCSW1083IMedicare ID - Type UnspecifiedPROVIDER #