Healthcare Provider Details

I. General information

NPI: 1891408761
Provider Name (Legal Business Name): ELIZABETH ANN MARTIN LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2023
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7822 EASTERN AVE
BALTIMORE MD
21224-2115
US

IV. Provider business mailing address

510 RED CLIFF RD
COLORADO SPRINGS CO
80906-4521
US

V. Phone/Fax

Practice location:
  • Phone: 800-847-6028
  • Fax: 800-847-6028
Mailing address:
  • Phone: 804-516-3837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number28562
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: