Healthcare Provider Details

I. General information

NPI: 1497279525
Provider Name (Legal Business Name): MICHELE MARTINI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PENNSYLVANIA AVE SE
WASHINGTON DC
20003-4316
US

IV. Provider business mailing address

PO BOX 73188
WASHINGTON DC
20056-3188
US

V. Phone/Fax

Practice location:
  • Phone: 202-341-0500
  • Fax:
Mailing address:
  • Phone: 202-341-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT000211
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: