Provider Demographics
NPI:1588990667
Name:MARTIN, SCOTT B (LICSW)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:B
Last Name:MARTIN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12158 SHOREWOOD DR SW
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98146-2424
Mailing Address - Country:US
Mailing Address - Phone:206-935-2982
Mailing Address - Fax:
Practice Address - Street 1:12158 SHOREWOOD DR SW
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98146-2424
Practice Address - Country:US
Practice Address - Phone:206-935-2982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000061231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical