1508855768 NPI number — MS. CATHERINE MARY MARTIN LCPC

Table of content: MS. CATHERINE MARY MARTIN LCPC (NPI 1508855768)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508855768 NPI number — MS. CATHERINE MARY MARTIN LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN
Provider First Name:
CATHERINE
Provider Middle Name:
MARY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARTIN-DAVIS
Provider Other First Name:
CATHERINE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1508855768
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4226 BAR HARBOR PLACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLNEY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20832-2966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-580-1563
Provider Business Mailing Address Fax Number:
301-929-9652

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1680 EAST GUDE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-580-1563
Provider Business Practice Location Address Fax Number:
301-929-9652
Provider Enumeration Date:
10/19/2005

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: 101YP2500X , with the licence number:  LCO491 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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