Provider Demographics
NPI:1194712067
Name:MARTIN, ANNE L (LICSW)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:L
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 WINSOR ST
Mailing Address - Street 2:STE 101
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-3469
Mailing Address - Country:US
Mailing Address - Phone:413-583-6750
Mailing Address - Fax:413-589-7001
Practice Address - Street 1:77 WINSOR ST
Practice Address - Street 2:STE 101
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-3469
Practice Address - Country:US
Practice Address - Phone:413-583-6750
Practice Address - Fax:413-589-7001
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1018012104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1892070Medicaid
MA1892070Medicaid