Provider Demographics
NPI:1023103017
Name:MARTIN, ANN MARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:MARIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:CURTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 6643
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97007-6643
Mailing Address - Country:US
Mailing Address - Phone:503-913-7096
Mailing Address - Fax:
Practice Address - Street 1:5700 SW DOSCH RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:503-913-7096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL28531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical