1447339148 NPI number — MR. MARTIN VICTOR PEARLMON LCSW CASAC

Table of content: MR. MARTIN VICTOR PEARLMON LCSW CASAC (NPI 1447339148)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447339148 NPI number — MR. MARTIN VICTOR PEARLMON LCSW CASAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEARLMON
Provider First Name:
MARTIN
Provider Middle Name:
VICTOR
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW CASAC
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:
1447339148
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:
ONE PINNACLE PL
Provider Second Line Business Mailing Address:
STE 220
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-482-5141
Provider Business Mailing Address Fax Number:
518-768-8096

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ONE PINNACLE PL
Provider Second Line Business Practice Location Address:
STE 220
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-482-5141
Provider Business Practice Location Address Fax Number:
518-768-8096
Provider Enumeration Date:
11/03/2006

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: 104100000X , with the licence number:  R0287961 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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