Provider Demographics
NPI:1275880700
Name:MARTEL, HEATHER MARIE (LMSW-CC)
Entity Type:Individual
Prefix:MR
First Name:HEATHER
Middle Name:MARIE
Last Name:MARTEL
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:MARIE
Other - Last Name:MARTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW-CC
Mailing Address - Street 1:899 RIVERSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1070
Mailing Address - Country:US
Mailing Address - Phone:207-871-1211
Mailing Address - Fax:207-871-1232
Practice Address - Street 1:50 PARK RD
Practice Address - Street 2:SUITE 4
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-3176
Practice Address - Country:US
Practice Address - Phone:207-856-0082
Practice Address - Fax:207-856-2861
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC128741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical