Provider Demographics
NPI:1134587959
Name:ROMAN-MARTIN, JENNIFER C (LICSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:ROMAN-MARTIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:C
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1269 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5248
Mailing Address - Country:US
Mailing Address - Phone:617-232-1303
Mailing Address - Fax:617-232-1280
Practice Address - Street 1:1269 BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5248
Practice Address - Country:US
Practice Address - Phone:617-232-1303
Practice Address - Fax:617-232-1280
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1213401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical