Provider Demographics
NPI:1326510900
Name:MARTIN, MARIA LYNN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:LYNN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12401 E. 17TH AVE
Mailing Address - Street 2:MAIL STOP F777
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-2548
Mailing Address - Country:US
Mailing Address - Phone:720-848-5197
Mailing Address - Fax:720-848-5206
Practice Address - Street 1:12605 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2545
Practice Address - Country:US
Practice Address - Phone:720-848-5197
Practice Address - Fax:720-848-5206
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9926321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical