Provider Demographics
NPI:1649601634
Name:MARTIN PROFESSIONAL
Entity Type:Organization
Organization Name:MARTIN PROFESSIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPY AND CONSULTING
Authorized Official - Prefix:
Authorized Official - First Name:PORSCHE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:646-398-7002
Mailing Address - Street 1:18 E 127TH ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-1296
Mailing Address - Country:US
Mailing Address - Phone:646-398-7002
Mailing Address - Fax:
Practice Address - Street 1:18 E 127TH ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-1296
Practice Address - Country:US
Practice Address - Phone:646-398-7002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY08054811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty