Provider Demographics
NPI:1073006714
Name:MARTIN, MICHAEL JR (MS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MARTIN
Suffix:JR
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HADDON TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08107-1034
Mailing Address - Country:US
Mailing Address - Phone:856-236-3379
Mailing Address - Fax:
Practice Address - Street 1:125 E PARK AVE
Practice Address - Street 2:
Practice Address - City:HADDON TWP
Practice Address - State:NJ
Practice Address - Zip Code:08107-1034
Practice Address - Country:US
Practice Address - Phone:856-236-3379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral