Healthcare Provider Details

I. General information

NPI: 1386863025
Provider Name (Legal Business Name): NEIL ALLAN MARTIN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9107 WILSHIRE BLVD SUITE 200
BEVERLY HILLS CA
90210-5531
US

IV. Provider business mailing address

8601 FALMOUTH AVE #203
PLAYA DEL REY CA
90293-8692
US

V. Phone/Fax

Practice location:
  • Phone: 310-922-0211
  • Fax:
Mailing address:
  • Phone: 310-922-0211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 22987
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: