Provider Demographics
NPI:1710769930
Name:MARTIN, VANESSA (COUNSELING INTER)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:COUNSELING INTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4427 GRANTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-3751
Mailing Address - Country:US
Mailing Address - Phone:440-319-1394
Mailing Address - Fax:
Practice Address - Street 1:1515 W 29TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-2906
Practice Address - Country:US
Practice Address - Phone:216-939-3700
Practice Address - Fax:216-334-2882
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor