MEDICARE: CHRISTINA MARTENSSON LCSW

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker		FL

General Provider Information

NPI Number	:	1982730248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA MARTENSSON LCSW

Provider Business Mailing Address
First Line	:	PO BOX 622
Second Line	:
City	:	CRYSTAL RIVER
State	:	FL
Zip	:	34423-0622
Country	:	US
Telephone Number	:	352-563-5372
Fax Number	:

Provider Business Practice Location Address
First Line	:	521 W FORT ISLAND TRL
Second Line	:	SUITE A
City	:	CRYSTAL RIVER
State	:	FL
Zip	:	34429-2413
Country	:	US
Telephone Number	:	352-563-5372
Fax Number	:

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

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	07/08/2007

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Directions to “ CHRISTINA MARTENSSON LCSW” Practice Location

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