Provider Demographics
NPI:1063917441
Name:MARTIN, JOSHUA (LMHC)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9106 REGENCY PARK APTS N
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-1439
Mailing Address - Country:US
Mailing Address - Phone:518-791-6524
Mailing Address - Fax:
Practice Address - Street 1:9106 REGENCY PARK APTS N
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-1439
Practice Address - Country:US
Practice Address - Phone:518-791-6524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008544-1101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional