Provider Demographics
NPI:1225248750
Name:LUDWIG, MARTIN P
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:P
Last Name:LUDWIG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 W SAMPLE RD
Mailing Address - Street 2:SUITE #244
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3470
Mailing Address - Country:US
Mailing Address - Phone:954-796-7246
Mailing Address - Fax:
Practice Address - Street 1:4400 W SAMPLE RD
Practice Address - Street 2:SUITE #244
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-3470
Practice Address - Country:US
Practice Address - Phone:954-796-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW16661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical