Provider Demographics
NPI:1891953055
Name:MARTIN, EVANGELIA KIM (LCSW)
Entity Type:Individual
Prefix:MS
First Name:EVANGELIA
Middle Name:KIM
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 1:303 WOLFS LN
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-2108
Mailing Address - Country:US
Mailing Address - Phone:914-633-3090
Mailing Address - Fax:914-633-3090
Practice Address - Street 1:303 WOLFS LN
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803-2108
Practice Address - Country:US
Practice Address - Phone:914-633-3090
Practice Address - Fax:914-633-3090
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR059038-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health