Provider Demographics
NPI:1891861829
Name:MARTIN, WILLIAM CHARLES (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CHARLES
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 1:11400 OVERSEAS HWY STE 224
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-3600
Mailing Address - Country:US
Mailing Address - Phone:305-906-0238
Mailing Address - Fax:305-434-9040
Practice Address - Street 1:11400 OVERSEAS HWY STE 224
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-3600
Practice Address - Country:US
Practice Address - Phone:305-906-0238
Practice Address - Fax:305-434-9040
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 66601041C0700X
CALCS 211811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q23985Medicare UPIN