Provider Demographics
NPI:1629340260
Name:DEBORAH A. MARTIN, INC.
Entity Type:Organization
Organization Name:DEBORAH A. MARTIN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:NUCE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:352-228-4969
Mailing Address - Street 1:708 NE 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34428-3704
Mailing Address - Country:US
Mailing Address - Phone:352-228-4969
Mailing Address - Fax:352-228-8901
Practice Address - Street 1:708 NE 6TH ST
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34428-3704
Practice Address - Country:US
Practice Address - Phone:352-228-4969
Practice Address - Fax:352-228-8901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-28
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002272900Medicaid