Provider Demographics
NPI:1659700938
Name:WARE, MARTHA (MSW)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:WARE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 RYBERRY DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-6436
Mailing Address - Country:US
Mailing Address - Phone:386-585-0740
Mailing Address - Fax:
Practice Address - Street 1:225 S SWOOPE AVE
Practice Address - Street 2:211
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5704
Practice Address - Country:US
Practice Address - Phone:407-622-0444
Practice Address - Fax:407-699-0444
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical