Provider Demographics
NPI:1821196544
Name:MARTIN, CHARLES R (MSS, LCSW)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:R
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MSS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 CAREDEAN DR
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-1321
Mailing Address - Country:US
Mailing Address - Phone:215-823-6050
Mailing Address - Fax:215-823-4425
Practice Address - Street 1:433 CAREDEAN DR
Practice Address - Street 2:
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-1321
Practice Address - Country:US
Practice Address - Phone:215-823-6050
Practice Address - Fax:215-823-4425
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW 000423-L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical