Provider Demographics
NPI:1669557070
Name:WHITFORD, MARTHA (LISAC)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:
Last Name:WHITFORD
Suffix:
Gender:F
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1046 E BUCKEYE RD
Mailing Address - Street 2:CPLC ADMINISTRATION
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034
Mailing Address - Country:US
Mailing Address - Phone:602-254-4827
Mailing Address - Fax:602-307-9752
Practice Address - Street 1:1402 S CENTRAL AVE
Practice Address - Street 2:CPLC VIA DE AMISTAD
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004
Practice Address - Country:US
Practice Address - Phone:602-257-5530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC 16281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical