1255362869 NPI number — MR. JOSEPH E MARTIN LCSW LCAS

Table of content: MR. JOSEPH E MARTIN LCSW LCAS (NPI 1255362869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255362869 NPI number — MR. JOSEPH E MARTIN LCSW LCAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN
Provider First Name:
JOSEPH
Provider Middle Name:
E
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW LCAS
Provider Gender Code:
M

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:
1255362869
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 397
Provider Second Line Business Mailing Address:
129 SKYVIEW CIRCLE
Provider Business Mailing Address City Name:
SPRUCE PINE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28777-9518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-765-0037
Provider Business Mailing Address Fax Number:
828-765-0039

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
129 SKYVIEW CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRUCE PINE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28777-9518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-765-0037
Provider Business Practice Location Address Fax Number:
828-765-0039
Provider Enumeration Date:
07/05/2006

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:  C001296 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6003034 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2862723B . This is a "MEDICARE ENROLLMENT FOR NEW VISTAS BEHAVIORAL HEALTH SERVICES, INC." identifier . This identifiers is of the category "OTHER".
  • Identifier: 2862723A . This is a "MEDICARE NUMBER FOR BLUE RIDGE CENTER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2862723C . This is a "MEDICARE ENROLLMENT FOR ALPHA OMEGA HEALTH, INC." identifier . This identifiers is of the category "OTHER".




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