Provider Demographics
NPI:1457441560
Name:CANTWELL, MARTA M (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:MARTA
Middle Name:M
Last Name:CANTWELL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6706 N 9TH AVE
Mailing Address - Street 2:SUITE C-5
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-9303
Mailing Address - Country:US
Mailing Address - Phone:850-471-1799
Mailing Address - Fax:850-471-1790
Practice Address - Street 1:6706 N 9TH AVE
Practice Address - Street 2:SUITE C-5
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-9303
Practice Address - Country:US
Practice Address - Phone:850-471-1799
Practice Address - Fax:850-471-1790
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 7220101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health