Provider Demographics
NPI:1316663149
Name:MARTIN, DAJA JEAN (LCSW)
Entity type:Individual
Prefix:
First Name:DAJA
Middle Name:JEAN
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 1:385 STATION RD
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:ME
Mailing Address - Zip Code:04238-3337
Mailing Address - Country:US
Mailing Address - Phone:207-402-1836
Mailing Address - Fax:
Practice Address - Street 1:179 LISBON ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7248
Practice Address - Country:US
Practice Address - Phone:207-241-9332
Practice Address - Fax:207-782-9011
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2025-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC252641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical