Healthcare Provider Details

I. General information

NPI: 1609112929
Provider Name (Legal Business Name): KAREN MARIE MARTIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 07/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 W 32ND ST 8TH FLOOR
NEW YORK NY
10001-3212
US

IV. Provider business mailing address

345 W 70TH ST #4F
NEW YORK NY
10023-3520
US

V. Phone/Fax

Practice location:
  • Phone: 212-564-2350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number074091
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: