Provider Demographics
NPI:1730314675
Name:MARTIN, VERONICA C (MA)
Entity Type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:C
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 HANCOCK AVE
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-3944
Mailing Address - Country:US
Mailing Address - Phone:219-229-5843
Mailing Address - Fax:
Practice Address - Street 1:2307 LAPORTE AVE STE 10
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-6997
Practice Address - Country:US
Practice Address - Phone:219-520-5623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99080966A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health