Provider Demographics
NPI:1437214962
Name:MARTIN, DOLORES M (MSSW, LCSW)
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MSSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 NOLTEMEYER WAY APT 2F
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-5959
Mailing Address - Country:US
Mailing Address - Phone:502-592-4039
Mailing Address - Fax:
Practice Address - Street 1:1106 TUNNEL HILL RD STE 100
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-8026
Practice Address - Country:US
Practice Address - Phone:270-765-2335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical