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General NPI Number Information
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NPI Number | 1669685145
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Entity Type | Individual
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Provider Name | CARLA LYNN MARTIN LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 146 ELM ST STE A-12
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City | CHESHIRE
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State | CT
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Zip | 06410-2808
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Country | US
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Telephone | 203-439-7545
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Fax |
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Provider Business Mailing Address
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Address Line | 141 FORGE DRIVE
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City | AVON
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State | CT
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Zip | 06001
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Country | US
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Telephone | 860-404-8846
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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 | 005635
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License Number State | CT
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