Provider Demographics
NPI:1063059210
Name:MARTIN, KRYSTIN (LSW)
Entity type:Individual
Prefix:
First Name:KRYSTIN
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 GARNET DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-4716
Mailing Address - Country:US
Mailing Address - Phone:609-864-2784
Mailing Address - Fax:
Practice Address - Street 1:9 HARDING HWY
Practice Address - Street 2:
Practice Address - City:ELMER
Practice Address - State:NJ
Practice Address - Zip Code:08318-4401
Practice Address - Country:US
Practice Address - Phone:856-358-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06329000104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker