Provider Demographics
NPI:1578985826
Name:MARTIN, LAURA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 1ST AVE SE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-3200
Mailing Address - Country:US
Mailing Address - Phone:319-294-1599
Mailing Address - Fax:
Practice Address - Street 1:4403 1ST AVE SE
Practice Address - Street 2:SUITE 307
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-3200
Practice Address - Country:US
Practice Address - Phone:319-294-1599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0079891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical