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General NPI Number Information
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NPI Number | 1528952926
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Entity Type | Individual
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Provider Name | MICHAEL GERHARD MARTIN LICSW
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Gender | Male
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Dates
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Enumeration Date | 06/09/2025
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 940 SAXTONS RIVER RD
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City | SAXTONS RIVER
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State | VT
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Zip | 05154-9701
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Country | US
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Telephone | 802-376-1516
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Fax |
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Provider Business Mailing Address
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Address Line | 940 SAXTONS RIVER RD
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City | SAXTONS RIVER
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State | VT
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Zip | 05154-9701
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Country | US
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Telephone | 508-423-2369
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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 | 089.0136582
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License Number State | VT
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