MEDICARE: MICHAEL MARTIN JR. MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	101YP1600X	Pastoral Counselor
4	101Y00000X	Counselor

General Provider Information

NPI Number	:	1073006714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL MARTIN JR. MS

Provider Business Mailing Address
First Line	:	125 E PARK AVE
Second Line	:
City	:	HADDON TWP
State	:	NJ
Zip	:	08107-1034
Country	:	US
Telephone Number	:	856-236-3379
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 E PARK AVE
Second Line	:
City	:	HADDON TWP
State	:	NJ
Zip	:	08107-1034
Country	:	US
Telephone Number	:	856-236-3379
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2018
Last Update Date	:	06/07/2018

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