| Doctor Name: | MR. KEITH STANLEY MARTIN |
| NPI Number: | 1003027046 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW |
| License Number: | LCS 15670 |
| Business Practice Address: | 9300 Valley Childrens Pl Madera, CA - 936388761 |
| Business Phone Number: | 5583533000 |
| Business Fax Number: | 5593535838 |
| Mailing Address: | 4507 W. Berkeley Avenue, FRESNO |
| State: | CA |
| Postal Code: | 93722 |
| Phone Number: | 5592761251 |
| Fax Number: | |
| NPI Enumeration Date: | 05/24/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LCS 15670 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |