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General NPI Number Information
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NPI Number | 1699341776
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Entity Type | Individual
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Provider Name | LESLIE BENITA MARTIN LMHC,LPC
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Gender | Female
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Dates
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Enumeration Date | 05/31/2021
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Last Update Date | 09/27/2022
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Provider Practice Location Address
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Address Line | 4500 W BRIGANTINE AVE APT 1103
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City | BRIGANTINE
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State | NJ
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Zip | 08203-1466
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Country | US
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Telephone | 917-251-0288
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 839
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City | BRIGANTINE
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State | NJ
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Zip | 08203-0839
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Country | US
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Telephone | 917-251-0288
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 001024
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00867300
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License Number State | NJ
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