Provider Demographics
NPI:1396863791
Name:MARTIN, LORI A (LCSW)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:MARTIN
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:PO BOX 602
Mailing Address - Street 2:
Mailing Address - City:MADAWASKA
Mailing Address - State:ME
Mailing Address - Zip Code:04756-0602
Mailing Address - Country:US
Mailing Address - Phone:207-436-9587
Mailing Address - Fax:207-728-3131
Practice Address - Street 1:272 MAIN STREET SUITE 103
Practice Address - Street 2:
Practice Address - City:MADAWASKA
Practice Address - State:ME
Practice Address - Zip Code:04756-0602
Practice Address - Country:US
Practice Address - Phone:207-436-9587
Practice Address - Fax:207-728-3131
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC116211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431878499OtherMAINE CARE NUMBER