Provider Demographics
NPI:1932276532
Name:LENZ, MARTHA JEAN (LICSW)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:JEAN
Last Name:LENZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:
Other - Last Name:NEEDLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:101 FORT HILL AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-5810
Mailing Address - Country:US
Mailing Address - Phone:413-445-7721
Mailing Address - Fax:
Practice Address - Street 1:333 EAST ST
Practice Address - Street 2:BRIEN CENTER
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-5312
Practice Address - Country:US
Practice Address - Phone:413-499-0412
Practice Address - Fax:413-499-0979
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1054201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA31666OtherHEALTH NEW ENGLAND
MA0000905326OtherBLUE CROSS BLUE SHIELD MA
MA0000905326OtherBLUE CROSS BLUE SHIELD MA