Provider Demographics
NPI:1619090446
Name:NATHAN, MARTIN (LCPC, LMHC)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:
Last Name:NATHAN
Suffix:
Gender:M
Credentials:LCPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16672 MADRID CT
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8339
Mailing Address - Country:US
Mailing Address - Phone:561-353-8474
Mailing Address - Fax:
Practice Address - Street 1:16672 MADRID CT
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8339
Practice Address - Country:US
Practice Address - Phone:561-353-8474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.000532101YP2500X
FLMH9849101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional