Provider Demographics
NPI:1336505783
Name:MARTINE LUNTZ
Entity Type:Organization
Organization Name:MARTINE LUNTZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CLARE
Authorized Official - Middle Name:ANDREA
Authorized Official - Last Name:STADLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CEDS
Authorized Official - Phone:919-602-6766
Mailing Address - Street 1:3622 LYCKAN PKWY
Mailing Address - Street 2:SUITE 3002
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2564
Mailing Address - Country:US
Mailing Address - Phone:919-602-6766
Mailing Address - Fax:
Practice Address - Street 1:3622 LYCKAN PKWY
Practice Address - Street 2:SUITE 3002
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2564
Practice Address - Country:US
Practice Address - Phone:919-602-6766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLARE A. STADLEN, LCSW, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048.0098908103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty