MEDICARE: MARTHA K ADEDOYIN CSW

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	44SW01141900	NJ

General Provider Information

NPI Number	:	1104119130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA K ADEDOYIN CSW

Provider Business Mailing Address
First Line	:	370 BERKELEY RD
Second Line	:
City	:	ORANGE
State	:	NJ
Zip	:	07050-2110
Country	:	US
Telephone Number	:	973-676-8899
Fax Number	:	973-677-9877

Provider Business Practice Location Address
First Line	:	370 BERKELEY RD
Second Line	:
City	:	ORANGE
State	:	NJ
Zip	:	07050-2110
Country	:	US
Telephone Number	:	973-676-8899
Fax Number	:	973-677-9877

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

Provider Enumeration Date	:	05/24/2011
Last Update Date	:	05/24/2011

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