Healthcare Provider Details

I. General information

NPI: 1285794651
Provider Name (Legal Business Name): MARTHA OTICE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 09/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9033 GLADES RD SUITE B
BOCA RATON FL
33434-3939
US

IV. Provider business mailing address

6181 BALBOA CIR #203
BOCA RATON FL
33433-8188
US

V. Phone/Fax

Practice location:
  • Phone: 561-361-0500
  • Fax: 561-479-0384
Mailing address:
  • Phone: 561-826-8770
  • Fax: 561-826-8770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: