Provider Demographics
NPI:1639264831
Name:SKELTON-PATRICK, MARTHA (LISW-CP)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:SKELTON-PATRICK
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:SKELTON
Other - Last Name:PATRICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW-CP
Mailing Address - Street 1:124 HILLBROOK DRIVE
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-3040
Mailing Address - Country:US
Mailing Address - Phone:864-582-5164
Mailing Address - Fax:
Practice Address - Street 1:124 HILLBROOK DRIVE (NOTE: RECEIVE PRACTICE MAIL HERE)
Practice Address - Street 2:(SEE PTS AT HOME &AT CH OFFS- SP'BURG & GAFFNEY, SC)
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-3040
Practice Address - Country:US
Practice Address - Phone:864-978-7166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0007541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC000754OtherSOC. WK (LISW) LICENSE #
SCQ32560Medicare ID - Type UnspecifiedPRACTITIONER ID
SC000754OtherSOC. WK (LISW) LICENSE #