Provider Demographics
NPI:1922242148
Name:BRICENO, MARTHA M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:M
Last Name:BRICENO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MARTHA
Other - Middle Name:M
Other - Last Name:RAMOS-BRICENO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:3330 STONEHENGE DR
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-7055
Mailing Address - Country:US
Mailing Address - Phone:646-753-4301
Mailing Address - Fax:
Practice Address - Street 1:244 GRAHAM AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-1204
Practice Address - Country:US
Practice Address - Phone:646-753-4301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-01
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0825671041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03471634Medicaid