1073519872 NPI number — LINDA A MARTIN LCSW,RN

Table of content: LINDA A MARTIN LCSW,RN (NPI 1073519872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073519872 NPI number — LINDA A MARTIN LCSW,RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN
Provider First Name:
LINDA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW,RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073519872
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1824 MURRAY AVE
Provider Second Line Business Mailing Address:
STE 305
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15217-1655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-521-2126
Provider Business Mailing Address Fax Number:
412-521-3995

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1824 MURRAY AVE
Provider Second Line Business Practice Location Address:
STE 305
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15217-1655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-521-2126
Provider Business Practice Location Address Fax Number:
412-521-3995
Provider Enumeration Date:
06/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  CW012880 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 762560 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PO38125 . This is a "TRICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 80-01786760 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0017867600001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 74795 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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