| Doctor Name: | MR. MARTIN WAKESBERG |
| NPI Number: | 1144281833 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSW |
| License Number: | R017417-1 |
| Business Practice Address: | 113 Saratoga Rd Glenville, NY - 123027100 |
| Business Phone Number: | 5183990637 |
| Business Fax Number: | 5183997195 |
| Mailing Address: | 1 Brierwood Ct, BURNT HILLS |
| State: | NY |
| Postal Code: | 120279451 |
| Phone Number: | 5183996741 |
| Fax Number: | 5183997195 |
| NPI Enumeration Date: | 03/31/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | R017417-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |