Provider Demographics
NPI:1841301348
Name:MARTIN, CAROL ANNE (MSW-ASW)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANNE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MSW-ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1049 12TH ST
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:91932-2930
Mailing Address - Country:US
Mailing Address - Phone:619-423-7656
Mailing Address - Fax:
Practice Address - Street 1:6160 MISSION GORGE RD
Practice Address - Street 2:120
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-3410
Practice Address - Country:US
Practice Address - Phone:619-283-5731
Practice Address - Fax:619-283-1877
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA147651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical