Healthcare Provider Details

I. General information

NPI: 1629340260
Provider Name (Legal Business Name): DEBORAH A. MARTIN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2012
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 N LECANTO HWY STE 532
LECANTO FL
34461-8547
US

IV. Provider business mailing address

508 N LECANTO HWY STE 532
LECANTO FL
34461-8547
US

V. Phone/Fax

Practice location:
  • Phone: 352-228-4969
  • Fax: 352-228-8901
Mailing address:
  • Phone: 352-228-4969
  • Fax: 352-228-8901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA A NUCE
Title or Position: OWNER
Credential: LCSW
Phone: 352-228-4969