Provider Demographics
NPI:1740384734
Name:MARTIN, JOSEPH MEINRAD (MSW)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:MEINRAD
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 MUMMA RD
Mailing Address - Street 2:GOOD HOPE PSYCHOTHERAPISTS
Mailing Address - City:WORMLEYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1147
Mailing Address - Country:US
Mailing Address - Phone:717-975-5525
Mailing Address - Fax:717-975-8815
Practice Address - Street 1:1035 MUMMA RD
Practice Address - Street 2:GOOD HOPE PSYCHOTHERAPISTS
Practice Address - City:WORMLEYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17043-1147
Practice Address - Country:US
Practice Address - Phone:717-975-5525
Practice Address - Fax:717-975-8815
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PALW000955L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA594765Medicare PIN
Q14077Medicare UPIN