Provider Demographics
NPI:1275938854
Name:MARTIN, GENEVIEVE MARIE (LSW)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:MARIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 HADDOCK RD
Mailing Address - Street 2:
Mailing Address - City:MCADOO
Mailing Address - State:PA
Mailing Address - Zip Code:18237-3130
Mailing Address - Country:US
Mailing Address - Phone:814-434-9376
Mailing Address - Fax:
Practice Address - Street 1:264 PIEDMONT DR
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-6940
Practice Address - Country:US
Practice Address - Phone:814-434-9376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-25
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0185021041C0700X
PASW129650104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical