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General NPI Number Information
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NPI Number | 1215316286
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Entity Type | Organization
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Legal Business Name | KATHLEEN S. MARTIN, MSW, LCSW,INC.
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Dates
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Enumeration Date | 05/24/2015
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Last Update Date | 04/15/2016
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Provider Practice Location Address
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Address Line | 3307 NORTHLAKE BLVD # B104 B104
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33403-1703
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Country | US
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Telephone | 561-694-5265
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Fax |
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Provider Business Mailing Address
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Address Line | 3307 NORTHLAKE BLVD # B1O4 B104
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33403-1703
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Country | US
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Telephone | 561-694-5265
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATHLEEN STONEBRINK MARTIN
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Credential | LCSW
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Telephone | 561-694-5265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW6384
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License Number State | FL
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