Provider Demographics
NPI:1598465957
Name:MARTIN, DANIEL L (LMSW)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:L
Last Name:MARTIN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4117 SW MISTY HARBOR AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66610-2330
Mailing Address - Country:US
Mailing Address - Phone:785-925-4440
Mailing Address - Fax:
Practice Address - Street 1:225 SW 12TH ST
Practice Address - Street 2:#210
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66612-1310
Practice Address - Country:US
Practice Address - Phone:785-925-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
KS13378104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30005036540001Medicaid