Provider Demographics
NPI:1194442061
Name:MARTONICK, CAROL (LSW)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:MARTONICK
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 TERRACE LN
Mailing Address - Street 2:
Mailing Address - City:SUGARLOAF
Mailing Address - State:PA
Mailing Address - Zip Code:18249-9786
Mailing Address - Country:US
Mailing Address - Phone:570-233-0672
Mailing Address - Fax:
Practice Address - Street 1:7 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701-1732
Practice Address - Country:US
Practice Address - Phone:570-961-3361
Practice Address - Fax:570-961-3364
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA132251104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker