MEDICARE: KATHLEEN STONEBRINK 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	SW6384	FL

General Provider Information

NPI Number	:	1881737732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN STONEBRINK MARTIN LCSW

Provider Business Mailing Address
First Line	:	2340 BAY VILLAGE CT
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33410-2580
Country	:	US
Telephone Number	:	561-694-5265
Fax Number	:

Provider Business Practice Location Address
First Line	:	3307 NORTHLAKE BLVD
Second Line	:	B104
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33403-1703
Country	:	US
Telephone Number	:	561-694-5265
Fax Number	:

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

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	07/08/2007

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