Doctor Name: | LORI RAE MARTIN |
NPI Number: | 1457486532 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSW |
License Number: | LCSW-2874 |
Business Practice Address: | 4301 E. Guadalupe Rd. Higley, AZ - 85296 |
Business Phone Number: | 4808130051 |
Business Fax Number: | 4808130258 |
Mailing Address: | 16843 S 13th Way, PHOENIX |
State: | AZ |
Postal Code: | 850484760 |
Phone Number: | 4804600820 |
Fax Number: | |
NPI Enumeration Date: | 02/22/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LCSW-2874 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |