Provider Demographics
NPI:1518605476
Name:MARTIN, ELIZABETH (IMH)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:IMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 DEL PRADO BLVD S STE 303
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-7222
Mailing Address - Country:US
Mailing Address - Phone:239-317-0265
Mailing Address - Fax:239-673-7681
Practice Address - Street 1:3501 DEL PRADO BLVD S STE 303
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-7222
Practice Address - Country:US
Practice Address - Phone:239-317-0265
Practice Address - Fax:239-673-7681
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-21
Last Update Date:2022-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH22021101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health