Provider Demographics
NPI:1821214586
Name:MASHBURN, MARTHA MAE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:MAE
Last Name:MASHBURN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-2333
Mailing Address - Country:US
Mailing Address - Phone:845-229-5370
Mailing Address - Fax:
Practice Address - Street 1:4232 ALBANY POST RD
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-1766
Practice Address - Country:US
Practice Address - Phone:914-456-6734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR038800-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN464HOtherMAGELLAN
NY7334046004OtherVALUE OPTIONS
NYP2797605OtherOXFORD
NY115657OtherUNITED BEHAVIORAL HEALTH
NY7334046004OtherVALUE OPTIONS