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NPI Code Detail

MEDICARE: MR. PAUL MARTIN LCSW

MEDICARE: MR. PAUL 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 WorkerR072778-1NY

General Provider Information

NPI Number : 1659843126
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PAUL MARTIN LCSW
Provider Business Mailing Address
First Line : 157 W 120TH ST
Second Line :
City : NEW YORK
State : NY
Zip : 10027-6430
Country : US
Telephone Number : 914-557-6866
Fax Number :
Provider Business Practice Location Address
First Line : 2139 ADAM CLAYTON POWELL JR BLVD
Second Line :
City : NEW YORK
State : NY
Zip : 10027-3719
Country : US
Telephone Number : 212-932-9009
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2018
Last Update Date : 12/21/2018

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