Provider Demographics
NPI:1235422494
Name:MARTIN-LOVE, BRIGDGETT (LCSW-C)
Entity Type:Individual
Prefix:
First Name:BRIGDGETT
Middle Name:
Last Name:MARTIN-LOVE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 134
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17342-0134
Mailing Address - Country:US
Mailing Address - Phone:717-428-0552
Mailing Address - Fax:
Practice Address - Street 1:10801 HICKORY RIDGE RD STE 215
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3871
Practice Address - Country:US
Practice Address - Phone:717-428-0552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-20
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD118141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical