Provider Demographics
NPI:1376631267
Name:GILMARTIN, MARC M (MA)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:M
Last Name:GILMARTIN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10940 NE 33RD PL
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-1432
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10940 NE 33RD PL
Practice Address - Street 2:SUITE 107
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-1432
Practice Address - Country:US
Practice Address - Phone:425-827-3030
Practice Address - Fax:425-822-2960
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00008395101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health