Provider Demographics
NPI:1629269436
Name:MARTIN, RAWNIE JAMES (MSW-LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:RAWNIE
Middle Name:JAMES
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MSW-LCSW-C
Other - Prefix:
Other - First Name:RAWN
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:5541 CAROL LN
Mailing Address - Street 2:
Mailing Address - City:STEWARTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17363-9456
Mailing Address - Country:US
Mailing Address - Phone:717-993-6418
Mailing Address - Fax:
Practice Address - Street 1:304 E PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286
Practice Address - Country:US
Practice Address - Phone:717-818-8397
Practice Address - Fax:410-339-4609
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD151781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty