Healthcare Provider Details

I. General information

NPI: 1063264190
Provider Name (Legal Business Name): DREW MARTINI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 E BELTLINE CT NE
GRAND RAPIDS MI
49525-9494
US

IV. Provider business mailing address

1034 HAMILTON AVE NW
GRAND RAPIDS MI
49504-4218
US

V. Phone/Fax

Practice location:
  • Phone: 616-666-3410
  • Fax:
Mailing address:
  • Phone: 586-601-6482
  • Fax:

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: MS. DREW KINGSBURY MARTINI
Title or Position: OWNER
Credential: LMSW
Phone: 586-601-6482