Provider Demographics
NPI:1356555643
Name:MARTIN, DANIEL JOHN (MS LCMHC LADC)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JOHN
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MS LCMHC LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1106
Mailing Address - Street 2:
Mailing Address - City:CASTLETON
Mailing Address - State:VT
Mailing Address - Zip Code:05735-1106
Mailing Address - Country:US
Mailing Address - Phone:802-291-4950
Mailing Address - Fax:
Practice Address - Street 1:15 GREENFIELD LN
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:12837-2106
Practice Address - Country:US
Practice Address - Phone:802-291-4950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008576Medicaid