Provider Demographics
NPI:1104119130
Name:ADEDOYIN, MARTHA K (CSW)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:K
Last Name:ADEDOYIN
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 BERKELEY RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-2110
Mailing Address - Country:US
Mailing Address - Phone:973-676-8899
Mailing Address - Fax:973-677-9877
Practice Address - Street 1:370 BERKELEY RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-2110
Practice Address - Country:US
Practice Address - Phone:973-676-8899
Practice Address - Fax:973-677-9877
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SW011419001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical