Provider Demographics
NPI:1467566984
Name:HETTINGER, MARTHA K (LCSW)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:K
Last Name:HETTINGER
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 1:104 S FRONT AVE
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-1614
Mailing Address - Country:US
Mailing Address - Phone:606-886-8572
Mailing Address - Fax:606-886-4433
Practice Address - Street 1:118 RIVER DR
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1597
Practice Address - Country:US
Practice Address - Phone:606-432-3143
Practice Address - Fax:606-437-5412
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000200268OtherANTHEM BC/BS
KY1166298OtherCHA
KY0675603Medicare ID - Type Unspecified
KY0653304Medicare ID - Type Unspecified
KY0675703Medicare ID - Type Unspecified
KY1266943Medicare ID - Type Unspecified
KY0366419Medicare ID - Type Unspecified
KY0675503Medicare ID - Type Unspecified
KY1166298OtherCHA
KYR81028Medicare UPIN
KY0662406Medicare ID - Type Unspecified
KY0371306Medicare ID - Type Unspecified