Provider Demographics
NPI:1215316286
Name:KATHLEEN S. MARTIN, MSW, LCSW,INC.
Entity type:Organization
Organization Name:KATHLEEN S. MARTIN, MSW, LCSW,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:STONEBRINK
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-694-5265
Mailing Address - Street 1:3307 NORTHLAKE BLVD # B1O4
Mailing Address - Street 2:B104
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33403-1703
Mailing Address - Country:US
Mailing Address - Phone:561-694-5265
Mailing Address - Fax:
Practice Address - Street 1:3307 NORTHLAKE BLVD # B104
Practice Address - Street 2:B104
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33403-1703
Practice Address - Country:US
Practice Address - Phone:561-694-5265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-24
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW63841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty