Provider Demographics
NPI:1407841380
Name:MARTINA, NANCY J M (LCSWR)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:J M
Last Name:MARTINA
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5784 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5702
Mailing Address - Country:US
Mailing Address - Phone:716-633-6863
Mailing Address - Fax:716-633-9106
Practice Address - Street 1:5784 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5702
Practice Address - Country:US
Practice Address - Phone:716-633-6863
Practice Address - Fax:716-633-9106
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0230841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0077832OtherVALUE OPTIONS/GHI
NY000503479001OtherBCBS OF WNY
NY6207981OtherINDEPENDENT HEALTH
NY00020238501OtherUNIVERA
NY00020238501OtherUNIVERA