Provider Demographics
NPI:1457480766
Name:MARTIN, JANE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 E 66TH ST
Mailing Address - Street 2:APT. 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-6543
Mailing Address - Country:US
Mailing Address - Phone:212-535-2286
Mailing Address - Fax:
Practice Address - Street 1:108 E 66TH ST
Practice Address - Street 2:APT. 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-6543
Practice Address - Country:US
Practice Address - Phone:212-535-2286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR021082-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN10451Medicare ID - Type UnspecifiedLCSW