1285795864 NPI number — MS. (DELORES) 'LYNNE' MARTINS MSW, LICSW, CT

Table of content: MS. (DELORES) 'LYNNE' MARTINS MSW, LICSW, CT (NPI 1285795864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285795864 NPI number — MS. (DELORES) 'LYNNE' MARTINS MSW, LICSW, CT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTINS
Provider First Name:
(DELORES)
Provider Middle Name:
'LYNNE'
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LICSW, CT
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:
1285795864
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 65253
Provider Second Line Business Mailing Address:
1919 70TH AVENUE WEST, SUITE D
Provider Business Mailing Address City Name:
UNIVERSITY PLACE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98464-1253
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-572-6880
Provider Business Mailing Address Fax Number:
253-572-9505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1919 70TH AVE W
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
UNIVERSITY PLACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98466-5541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-572-6880
Provider Business Practice Location Address Fax Number:
253-572-9505
Provider Enumeration Date:
12/13/2006

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:  LW00004744 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 156086 . This is a "MANAGED HEALTH NETWORK" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 156089 . This is a "AETNA HEALTHCARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1938MA . This is a "REGENCE BLUESHIELD OF WA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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