Provider Demographics
NPI:1285795864
Name:MARTINS, (DELORES) 'LYNNE' (MSW, LICSW, CT)
Entity type:Individual
Prefix:MS
First Name:(DELORES)
Middle Name:'LYNNE'
Last Name:MARTINS
Suffix:
Gender:F
Credentials:MSW, LICSW, CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 65253
Mailing Address - Street 2:1919 70TH AVENUE WEST, SUITE D
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98464-1253
Mailing Address - Country:US
Mailing Address - Phone:253-572-6880
Mailing Address - Fax:253-572-9505
Practice Address - Street 1:1919 70TH AVE W
Practice Address - Street 2:SUITE D
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-5541
Practice Address - Country:US
Practice Address - Phone:253-572-6880
Practice Address - Fax:253-572-9505
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000047441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA156086OtherMANAGED HEALTH NETWORK
WA156089OtherAETNA HEALTHCARE
WA1938MAOtherREGENCE BLUESHIELD OF WA