Provider Demographics
NPI:1215190806
Name:MARTIN, PORSCHE
Entity Type:Individual
Prefix:
First Name:PORSCHE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 E 127TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-1296
Mailing Address - Country:US
Mailing Address - Phone:347-871-3522
Mailing Address - Fax:347-620-9512
Practice Address - Street 1:353 LEXINGTON AVENUE
Practice Address - Street 2:SUITE 200, #4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:347-871-3522
Practice Address - Fax:347-620-9512
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY08054811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical