MEDICARE: ERIN MARTINACHE LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	60231535	WA

General Provider Information

NPI Number	:	1003212770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN MARTINACHE LICSW

Provider Business Mailing Address
First Line	:	2146 W RAILROAD AVE # 4
Second Line	:
City	:	SHELTON
State	:	WA
Zip	:	98584-7126
Country	:	US
Telephone Number	:	360-463-5015
Fax Number	:	360-462-0289

Provider Business Practice Location Address
First Line	:	2146 W RAILROAD AVE
Second Line	:
City	:	SHELTON
State	:	WA
Zip	:	98584-7126
Country	:	US
Telephone Number	:	360-463-5015
Fax Number	:	360-462-0289

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2014
Last Update Date	:	12/08/2022

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