Provider Demographics
NPI:1316199219
Name:MARTINI, NICOLE LOUISE (LCSW-P)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LOUISE
Last Name:MARTINI
Suffix:
Gender:F
Credentials:LCSW-P
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LOUISE
Other - Last Name:BENTZEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:95 BRADHURST AVE
Mailing Address - Street 2:
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1637
Mailing Address - Country:US
Mailing Address - Phone:914-831-2458
Mailing Address - Fax:914-347-5544
Practice Address - Street 1:95 BRADHURST AVE
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1637
Practice Address - Country:US
Practice Address - Phone:914-831-2458
Practice Address - Fax:914-347-5544
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP063065-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical