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General NPI Number Information
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NPI Number | 1487419354
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Entity Type | Individual
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Provider Name | HEATHER K. MARTIN JD, LSW
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Gender | Female
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Dates
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Enumeration Date | 02/19/2024
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 34 SYCAMORE AVE STE 2E
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City | LITTLE SILVER
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State | NJ
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Zip | 07739-1248
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Country | US
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Telephone | 732-503-9047
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Fax |
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Provider Business Mailing Address
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Address Line | 56 VIOLET CT
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City | TOMS RIVER
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State | NJ
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Zip | 08753-1316
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Country | US
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Telephone | 732-567-7509
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SL07076100
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License Number State | NJ
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