MEDICARE: MR. MARTIN THOMAS KLEHN LISW/LADAC

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	I-04823	NM

General Provider Information

NPI Number	:	1316100274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARTIN THOMAS KLEHN LISW/LADAC

Provider Business Mailing Address
First Line	:	PO BOX 2635
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87504-2635
Country	:	US
Telephone Number	:	505-438-1853
Fax Number	:	505-438-2475

Provider Business Practice Location Address
First Line	:	1911 5TH ST
Second Line	:	SUITE 101
City	:	SANTA FE
State	:	NM
Zip	:	87505-5403
Country	:	US
Telephone Number	:	505-438-1853
Fax Number	:	505-438-2475

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

Provider Enumeration Date	:	07/09/2008
Last Update Date	:	07/09/2008

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Directions to “ MR. MARTIN THOMAS KLEHN LISW/LADAC” Practice Location

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