Provider Demographics
NPI:1316663149
Name:MARTIN, DAJA JEAN (LMSW-CC)
Entity type:Individual
Prefix:
First Name:DAJA
Middle Name:JEAN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C/O ST MARYS HEALTH SYSTEM- PROVIDER ENROLLMENT
Mailing Address - Street 2:PO BOX 7291, LEWISTON, ME 04243-7291
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243
Mailing Address - Country:US
Mailing Address - Phone:207-777-8950
Mailing Address - Fax:
Practice Address - Street 1:1230 MAINE ST RM A
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:ME
Practice Address - Zip Code:04274-7325
Practice Address - Country:US
Practice Address - Phone:207-998-4483
Practice Address - Fax:207-998-2189
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC21571104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker