Provider Demographics
NPI:1285794651
Name:OTICE, MARTHA (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:
Last Name:OTICE
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 1:6181 BALBOA CIR
Mailing Address - Street 2:#203
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-8188
Mailing Address - Country:US
Mailing Address - Phone:561-826-8770
Mailing Address - Fax:561-826-8770
Practice Address - Street 1:9033 GLADES RD
Practice Address - Street 2:SUITE B
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3939
Practice Address - Country:US
Practice Address - Phone:561-361-0500
Practice Address - Fax:561-479-0384
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLER907AMedicare PIN