Provider Demographics
NPI:1811054950
Name:MARTIN, DENNIS MICHAEL (LICSW)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:MICHAEL
Last Name:MARTIN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 VALENTINE ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-4223
Mailing Address - Country:US
Mailing Address - Phone:508-677-0983
Mailing Address - Fax:
Practice Address - Street 1:413 HIGH ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-3306
Practice Address - Country:US
Practice Address - Phone:509-677-9091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1063421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP08357OtherBLUE CROSS OF MASSACHUSET
MAP08357OtherBLUE CROSS OF MASSACHUSET