Provider Demographics
NPI:1437424363
Name:HEWETT, MARTHA (MS,LMFT)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:
Last Name:HEWETT
Suffix:
Gender:F
Credentials:MS,LMFT
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 740856
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32774-0856
Mailing Address - Country:US
Mailing Address - Phone:386-774-8367
Mailing Address - Fax:
Practice Address - Street 1:1211 3RD ST
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-4111
Practice Address - Country:US
Practice Address - Phone:386-774-8367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-10
Last Update Date:2012-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1938101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health