Provider Demographics
NPI:1215969555
Name:MARTIN, HEATHER M (LCSW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
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 1:6507 WILKINS AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-1305
Mailing Address - Country:US
Mailing Address - Phone:412-335-1427
Mailing Address - Fax:412-223-4953
Practice Address - Street 1:6507 WILKINS AVE STE 103
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-1305
Practice Address - Country:US
Practice Address - Phone:412-335-1427
Practice Address - Fax:412-223-4353
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0727061041C0700X
NY0764231041C0700X
PACW0163621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
A400006100Medicare PIN