Provider Demographics
NPI:1669608642
Name:MARTIN, MARINA (LPC)
Entity type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 ROUTE 6 AND 209
Mailing Address - Street 2:STE 3B
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-9490
Mailing Address - Country:US
Mailing Address - Phone:570-296-1742
Mailing Address - Fax:570-296-4044
Practice Address - Street 1:396 ROUTE 6 AND 209
Practice Address - Street 2:STE 3B
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-9490
Practice Address - Country:US
Practice Address - Phone:570-296-1742
Practice Address - Fax:570-296-4044
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003697101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC003697OtherLICENSE NUMBER