| Doctor Name: | KEITH MARTIN |
| NPI Number: | 1013211663 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | PSW800 |
| Business Practice Address: | 1720 S Gadsden St Tallahassee, FL - 323015506 |
| Business Phone Number: | 8505764073 |
| Business Fax Number: | 8505768259 |
| Mailing Address: | 1720 S Gadsden St, TALLAHASSEE |
| State: | FL |
| Postal Code: | 323015506 |
| Phone Number: | 8505764073 |
| Fax Number: | 8505768259 |
| NPI Enumeration Date: | 12/22/2010 |
| NPI Last Update Date: | 12/23/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | PSW800 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |