Provider Demographics
NPI:1437932977
Name:MARTIN, TONY (ASW)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 NORTHGATE DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-3169
Mailing Address - Country:US
Mailing Address - Phone:310-614-6872
Mailing Address - Fax:
Practice Address - Street 1:602 NORTHGATE DR
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-3169
Practice Address - Country:US
Practice Address - Phone:310-614-6872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1173781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical