Provider Demographics
NPI:1457860280
Name:MARTIN, JANE (LPC, LCMHC)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:663 GUYETTE RD
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05667-9054
Mailing Address - Country:US
Mailing Address - Phone:609-598-2182
Mailing Address - Fax:609-818-9206
Practice Address - Street 1:663 GUYETTE RD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:VT
Practice Address - Zip Code:05667-9054
Practice Address - Country:US
Practice Address - Phone:609-598-2182
Practice Address - Fax:609-818-9206
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00454700101YP2500X
VT068.0131439101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional