Provider Demographics
NPI:1346526753
Name:MARTIN, WESTON (LCMHC)
Entity Type:Individual
Prefix:MR
First Name:WESTON
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 LEAVITT RD
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03263-3203
Mailing Address - Country:US
Mailing Address - Phone:866-746-1184
Mailing Address - Fax:
Practice Address - Street 1:14 LEAVITT RD
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:NH
Practice Address - Zip Code:03263-3203
Practice Address - Country:US
Practice Address - Phone:866-746-1184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-30
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3111857Medicaid