Provider Demographics
NPI:1669001673
Name:MARTIN, KAREN (LGSW, MSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LGSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 ALDERSHOT DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25405-5806
Mailing Address - Country:US
Mailing Address - Phone:304-886-1946
Mailing Address - Fax:
Practice Address - Street 1:115 AIKENS CTR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-6210
Practice Address - Country:US
Practice Address - Phone:304-820-9365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP009444380104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker