Provider Demographics
NPI:1124319363
Name:MARTIN, AMBER L (LCSW)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:L
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 BRIGHTWOOD PL
Mailing Address - Street 2:APT D
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-3352
Mailing Address - Country:US
Mailing Address - Phone:239-321-4930
Mailing Address - Fax:
Practice Address - Street 1:107 BRIGHTWOOD PL
Practice Address - Street 2:APT D
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-3352
Practice Address - Country:US
Practice Address - Phone:239-321-4930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX132781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical