Provider Demographics
NPI:1811279391
Name:MARTIN, REBECCA LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LYNN
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:8419 SHARON MERCER RD STE 3
Mailing Address - Street 2:
Mailing Address - City:MERCER
Mailing Address - State:PA
Mailing Address - Zip Code:16137-3169
Mailing Address - Country:US
Mailing Address - Phone:724-923-4374
Mailing Address - Fax:724-981-9350
Practice Address - Street 1:8419 SHARON MERCER RD STE 3
Practice Address - Street 2:
Practice Address - City:MERCER
Practice Address - State:PA
Practice Address - Zip Code:16137-3169
Practice Address - Country:US
Practice Address - Phone:724-856-0659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0182941041C0700X
TX58622104100000X
OHS.1100640104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0210850Medicaid
PA1029617040013Medicaid