Provider Demographics
NPI:1649347709
Name:MARTIN, JANET N (LCSW)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:N
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 PASCOE BLVD
Mailing Address - Street 2:SUITE100
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-6301
Mailing Address - Country:US
Mailing Address - Phone:270-846-0802
Mailing Address - Fax:270-843-1888
Practice Address - Street 1:351 PASCOE BLVD
Practice Address - Street 2:SUITE100
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-6301
Practice Address - Country:US
Practice Address - Phone:270-846-0802
Practice Address - Fax:270-843-1888
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8200083700Medicaid
KY8200083700Medicaid