Provider Demographics
NPI:1780931907
Name:MARTIN, CARRIE CLEM (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:CLEM
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 1:3201 TWILIGHT TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-2612
Mailing Address - Country:US
Mailing Address - Phone:512-203-3231
Mailing Address - Fax:
Practice Address - Street 1:3201 TWILIGHT TRL
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-2612
Practice Address - Country:US
Practice Address - Phone:512-203-3231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX176781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical