Provider Demographics
NPI:1619336922
Name:MARTIN, COLLEEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8835 HILLSIDE WAY
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:PA
Mailing Address - Zip Code:17268-7617
Mailing Address - Country:US
Mailing Address - Phone:301-991-4358
Mailing Address - Fax:717-267-7403
Practice Address - Street 1:176 S COLDBROOK AVE
Practice Address - Street 2:UNIT 2
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-2714
Practice Address - Country:US
Practice Address - Phone:717-267-7480
Practice Address - Fax:717-267-7403
Is Sole Proprietor?:No
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0179701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical