Provider Demographics
NPI:1306001342
Name:MARTIN, ANNA C (MSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:C
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:MS
Other - First Name:ANNA
Other - Middle Name:C
Other - Last Name:JEAN-GUILLAUME
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:410 STATE ST
Mailing Address - Street 2:SUITE NUMBER 6
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-3147
Mailing Address - Country:US
Mailing Address - Phone:203-606-2071
Mailing Address - Fax:203-287-8144
Practice Address - Street 1:861 MIDDLETOWN AVE
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-3536
Practice Address - Country:US
Practice Address - Phone:203-606-2071
Practice Address - Fax:203-287-8144
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CT0082921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical