Provider Demographics
NPI:1316083900
Name:MARTIN, JUDY (LCSW)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
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 1:1647 BROOKHOUSE CT
Mailing Address - Street 2:#248
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231
Mailing Address - Country:US
Mailing Address - Phone:941-866-3992
Mailing Address - Fax:941-953-2083
Practice Address - Street 1:330 S PINEAPPLE AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236
Practice Address - Country:US
Practice Address - Phone:941-866-3992
Practice Address - Fax:941-953-2083
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW40201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ6880Medicare PIN