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General NPI Number Information
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NPI Number | 1225393572
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Entity Type | Individual
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Provider Name | RAPHAEL MARTINS MSW
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Gender | Male
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Dates
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Enumeration Date | 07/11/2012
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Last Update Date | 01/12/2023
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Provider Practice Location Address
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Address Line | 700 CHIEF EDDIE HOFFMAN HIGHWAY
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City | BETHEL
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State | AK
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Zip | 99559-0287
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Country | US
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Telephone | 907-543-6300
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Fax | 907-543-6366
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Provider Business Mailing Address
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Address Line | 48 ASPEN GROVE DR E APT O-12
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City | EVANSTON
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State | WY
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Zip | 82930-4829
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Country | US
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Telephone | 907-545-0955
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 181062
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License Number State | AK
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