Provider Demographics
NPI:1346270378
Name:MARTELL, PATRICIA L (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:MARTELL
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 1:420 E 73RD ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-1621
Mailing Address - Country:US
Mailing Address - Phone:816-401-4976
Mailing Address - Fax:
Practice Address - Street 1:8016 STATE LINE RD STE 205
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3713
Practice Address - Country:US
Practice Address - Phone:816-401-4976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW0033421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO27228051OtherBLUE CROSS BLUE SHIELD OF KANSAS CITY