Provider Demographics
NPI:1649468919
Name:MARTINAT, KAREN M (LCSW)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:MARTINAT
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 1:691 CREEKSIDE WAY
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4706
Mailing Address - Country:US
Mailing Address - Phone:208-731-2214
Mailing Address - Fax:
Practice Address - Street 1:276 EASTLAND DR N
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4458
Practice Address - Country:US
Practice Address - Phone:208-731-2214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW 259841041C0700X
IDLCSW-311431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical