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NPI Code Detail

MEDICARE: JUSTIN MARTIN LCSW

MEDICARE: JUSTIN MARTIN LCSW
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
11041C0700XClinical Social Worker8446-CNV
21041C0700XClinical Social WorkerI.1901465OH
31041C0700XClinical Social WorkerLCSW-20365AZ

General Provider Information

NPI Number : 1265930655
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN MARTIN LCSW
Provider Business Mailing Address
First Line : 2121 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-2205
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2121 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-2205
Country : US
Telephone Number : 702-727-4360
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2018
Last Update Date : 08/22/2023

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Directions to “ JUSTIN MARTIN LCSW” Practice Location

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