Provider Demographics
NPI:1619246998
Name:MARTIN, REBECCA A (LCPC-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:ME
Mailing Address - Zip Code:04346-5146
Mailing Address - Country:US
Mailing Address - Phone:207-629-7025
Mailing Address - Fax:
Practice Address - Street 1:28 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:ME
Practice Address - Zip Code:04346-5146
Practice Address - Country:US
Practice Address - Phone:207-629-7025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3890101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional