Provider Demographics
NPI:1235532862
Name:MARTINICO, LEA ANN (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LEA ANN
Middle Name:
Last Name:MARTINICO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1557 LEROY ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1656
Mailing Address - Country:US
Mailing Address - Phone:313-244-8640
Mailing Address - Fax:
Practice Address - Street 1:377 FISHER RD STE D2
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE FARMS
Practice Address - State:MI
Practice Address - Zip Code:48230-1673
Practice Address - Country:US
Practice Address - Phone:313-316-5586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-26
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical