Provider Demographics
NPI:1912922006
Name:MARTIN, DEBORAH ALETA (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ALETA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 DUGWAY RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04009-4405
Mailing Address - Country:US
Mailing Address - Phone:207-647-9766
Mailing Address - Fax:
Practice Address - Street 1:150 DUGWAY RD
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-4405
Practice Address - Country:US
Practice Address - Phone:207-647-9766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC55391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical