Provider Demographics
NPI:1689899106
Name:DEUTCH, MARTHA I (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:I
Last Name:DEUTCH
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DICKINSON CT
Mailing Address - Street 2:
Mailing Address - City:LEDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07852-2304
Mailing Address - Country:US
Mailing Address - Phone:973-927-6540
Mailing Address - Fax:973-927-0627
Practice Address - Street 1:10 DICKINSON CT
Practice Address - Street 2:
Practice Address - City:LEDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07852-2304
Practice Address - Country:US
Practice Address - Phone:973-927-6540
Practice Address - Fax:973-927-0627
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC004887001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ698693Medicare ID - Type UnspecifiedPROVIDER NUMBER