Healthcare Provider Details

I. General information

NPI: 1902274137
Provider Name (Legal Business Name): LAURA PAYNE MARTINEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA MCKINLEY PAYNE LCSW

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2059 NEWMAN RD
LANGLEY WA
98260-9754
US

IV. Provider business mailing address

2059 NEWMAN RD
LANGLEY WA
98260-9754
US

V. Phone/Fax

Practice location:
  • Phone: 360-730-2459
  • Fax:
Mailing address:
  • Phone: 360-730-2459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number30988
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: