Provider Demographics
NPI:1619090446
Name:NATHAN, MARTIN (LCPC, LMHC)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:
Last Name:NATHAN
Suffix:
Gender:M
Credentials:LCPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22701 CAMINO DEL MAR
Mailing Address - Street 2:22
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-8723
Mailing Address - Country:US
Mailing Address - Phone:561-245-8135
Mailing Address - Fax:
Practice Address - Street 1:22701 CAMINO DEL MAR
Practice Address - Street 2:22
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-8723
Practice Address - Country:US
Practice Address - Phone:561-245-8135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9849101YM0800X
IL180.000532101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional