MEDICARE: JANINE MARIE 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
1	1041C0700X	Clinical Social Worker	44SC05527200	NJ

General Provider Information

NPI Number	:	1487089025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANINE MARIE MARTIN LCSW

Provider Business Mailing Address
First Line	:	166 MERRITT AVE
Second Line	:
City	:	BERGENFIELD
State	:	NJ
Zip	:	07621-1413
Country	:	US
Telephone Number	:	201-638-4718
Fax Number	:

Provider Business Practice Location Address
First Line	:	967 HAMBURG TPKE
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-3263
Country	:	US
Telephone Number	:	973-903-1109
Fax Number	:

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

Provider Enumeration Date	:	09/12/2013
Last Update Date	:	09/12/2013

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