Healthcare Provider Details

I. General information

NPI: 1811279391
Provider Name (Legal Business Name): REBECCA LYNN MARTIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA LYNN MEYER LCSW

II. Dates (important events)

Enumeration Date: 09/12/2011
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8419 SHARON MERCER RD STE 3
MERCER PA
16137-3169
US

IV. Provider business mailing address

8419 SHARON MERCER RD STE 3
MERCER PA
16137-3169
US

V. Phone/Fax

Practice location:
  • Phone: 724-856-0659
  • Fax:
Mailing address:
  • Phone: 724-923-4374
  • Fax: 724-981-9350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number58622
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1100640
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW018294
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: