| Angela Martin Psychotherapy, Llc | |
|
6021 Durand Ave Racine WI 53406-5096 | |
| (262) 554-0126 | |
| Not Available |
| Full Name | Angela Martin Psychotherapy, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 6021 Durand Ave, Racine, Wisconsin |
| Authorized Official Name and Position | Angela Martin (PRESIDENT) |
| Authorized Official Contact | 2625153220 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Angela Martin Psychotherapy, Llc 5930 5th Ave Kenosha WI 53140-4214 Ph: () - | Angela Martin Psychotherapy, Llc 6021 Durand Ave Racine WI 53406-5096 Ph: (262) 554-0126 |
| NPI Number | 1578688057 |
|---|---|
| Provider Enumeration Date | 03/21/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578688057 | NPI | - | NPPES |
| 39746200 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 6568-123 (Wisconsin) | Primary |
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