Provider Demographics
NPI:1376120006
Name:MARTIN, KERRIE (LMSW)
Entity Type:Individual
Prefix:
First Name:KERRIE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 W 86TH ST # 414
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3113
Mailing Address - Country:US
Mailing Address - Phone:917-330-4797
Mailing Address - Fax:
Practice Address - Street 1:345 W 86TH ST # 414
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3113
Practice Address - Country:US
Practice Address - Phone:917-330-4797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-27
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0992831104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker