Provider Demographics
NPI:1578560678
Name:MARTH, DEAN W (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:W
Last Name:MARTH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MAPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-1739
Mailing Address - Country:US
Mailing Address - Phone:573-443-8048
Mailing Address - Fax:573-443-8048
Practice Address - Street 1:PARKADE PLAZA 601 BUSINESS LOOP 70W
Practice Address - Street 2:STE 134G
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203
Practice Address - Country:US
Practice Address - Phone:573-443-8048
Practice Address - Fax:573-443-8048
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0054161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical