Provider Demographics
NPI:1396112678
Name:MARTINO, SARA MARIE (LPC)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:MARIE
Last Name:MARTINO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 OHIO TRL
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-8931
Mailing Address - Country:US
Mailing Address - Phone:609-654-0684
Mailing Address - Fax:
Practice Address - Street 1:19 OHIO TRL
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-8931
Practice Address - Country:US
Practice Address - Phone:609-654-0684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00394400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional