Provider Demographics
NPI:1154197481
Name:ORGANISTA, MARTHA C (LISCW)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:C
Last Name:ORGANISTA
Suffix:
Gender:F
Credentials:LISCW
Other - Prefix:
Other - First Name:MARTHA CECILIA
Other - Middle Name:
Other - Last Name:COSGROVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:823 HARDENBERGH PL # 1
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-5437
Mailing Address - Country:US
Mailing Address - Phone:218-269-2423
Mailing Address - Fax:
Practice Address - Street 1:797 7TH ST E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-5070
Practice Address - Country:US
Practice Address - Phone:651-379-4274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN293201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical