Provider Demographics
NPI:1679169403
Name:MARTIN, ERICA B (LCSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:B
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSW, LICSW
Other - Prefix:MRS
Other - First Name:ERICA
Other - Middle Name:B
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3300 NW 185TH AVE # 280
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-3406
Mailing Address - Country:US
Mailing Address - Phone:209-623-8595
Mailing Address - Fax:209-623-8595
Practice Address - Street 1:10260 SW GREENBURG RD FL 4
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-5500
Practice Address - Country:US
Practice Address - Phone:209-623-8595
Practice Address - Fax:503-972-1411
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical