Provider Demographics
NPI:1518602184
Name:PARADIS, MARTHA (LCSW)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:PARADIS
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 1:111 SERPENTINE RD
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2720
Mailing Address - Country:US
Mailing Address - Phone:201-665-4066
Mailing Address - Fax:
Practice Address - Street 1:111 SERPENTINE RD
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2720
Practice Address - Country:US
Practice Address - Phone:201-665-4066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC006733001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty