Provider Demographics
NPI:1457654048
Name:MARTIN, CHERYL LYNN (MSW, BCBA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MSW, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 HILL RD N
Mailing Address - Street 2:PMB 176
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-8888
Mailing Address - Country:US
Mailing Address - Phone:740-739-3693
Mailing Address - Fax:
Practice Address - Street 1:1209 HILL RD N
Practice Address - Street 2:PMB 176
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-8888
Practice Address - Country:US
Practice Address - Phone:740-739-3693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-21
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0500782104100000X
IL150.003366104100000X
OH1-05-2286103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No104100000XBehavioral Health & Social Service ProvidersSocial Worker