Provider Demographics
NPI:1811633779
Name:MARTIN, ANDREW W
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:W
Last Name:MARTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 HATHAWAY PARK
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-6162
Mailing Address - Country:US
Mailing Address - Phone:717-274-7598
Mailing Address - Fax:717-274-7599
Practice Address - Street 1:204 HATHAWAY PARK
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-6162
Practice Address - Country:US
Practice Address - Phone:717-274-7598
Practice Address - Fax:717-274-7599
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health