Provider Demographics
NPI:1851408850
Name:MARTIN, IRIS M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:IRIS
Middle Name:M
Last Name:MARTIN
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 1:654 BEERS ST
Mailing Address - Street 2:
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1452
Mailing Address - Country:US
Mailing Address - Phone:732-888-1551
Mailing Address - Fax:
Practice Address - Street 1:654 BEERS ST
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1452
Practice Address - Country:US
Practice Address - Phone:732-888-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00155600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
637228Medicare ID - Type Unspecified