Provider Demographics
NPI:1275863995
Name:MARTIN, ROBERT GENE (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:GENE
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MSW, LCSW
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 786
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-0786
Mailing Address - Country:US
Mailing Address - Phone:615-712-7742
Mailing Address - Fax:615-712-7768
Practice Address - Street 1:1315 CENTRAL CT
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-3153
Practice Address - Country:US
Practice Address - Phone:615-712-7742
Practice Address - Fax:615-712-7768
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-31
Last Update Date:2011-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW38471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical