Provider Demographics
NPI:1740493956
Name:MARTELL, GLORIA TERESE (MSW, LMSW, ACSW, SSW)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:TERESE
Last Name:MARTELL
Suffix:
Gender:F
Credentials:MSW, LMSW, ACSW, SSW
Other - Prefix:MS
Other - First Name:GLORIA
Other - Middle Name:TERESE
Other - Last Name:RACHOZA-MARTELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LMSW, ACSW, SSW
Mailing Address - Street 1:2525 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-9262
Mailing Address - Country:US
Mailing Address - Phone:734-323-1355
Mailing Address - Fax:517-266-2763
Practice Address - Street 1:220 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-2749
Practice Address - Country:US
Practice Address - Phone:517-265-5352
Practice Address - Fax:517-263-6090
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010637211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical