Provider Demographics
NPI:1891836474
Name:MARTIN, MICHAEL EDWARD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:EDWARD
Last Name:MARTIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 NEW STINE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-3696
Mailing Address - Country:US
Mailing Address - Phone:661-322-4000
Mailing Address - Fax:661-873-9314
Practice Address - Street 1:1601 NEW STINE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-3696
Practice Address - Country:US
Practice Address - Phone:661-322-4000
Practice Address - Fax:661-873-9314
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS51591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical