1740493956 NPI number — GLORIA TERESE MARTELL MSW, LMSW, ACSW, SSW

Table of content: GLORIA TERESE MARTELL MSW, LMSW, ACSW, SSW (NPI 1740493956)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740493956 NPI number — GLORIA TERESE MARTELL MSW, LMSW, ACSW, SSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTELL
Provider First Name:
GLORIA
Provider Middle Name:
TERESE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LMSW, ACSW, SSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RACHOZA-MARTELL
Provider Other First Name:
GLORIA
Provider Other Middle Name:
TERESE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LMSW, ACSW, SSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1740493956
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2525 CRESTWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ADRIAN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49221-9262
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-323-1355
Provider Business Mailing Address Fax Number:
517-266-2763

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ADRIAN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49221-2749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-265-5352
Provider Business Practice Location Address Fax Number:
517-263-6090
Provider Enumeration Date:
05/07/2007

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:  6801063721 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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