| Janice Martin Licensed Clinical Social Worker Pc | |
|
710 Main St Port Jefferson NY 11777-2278 | |
| (631) 680-7222 | |
| Not Available |
| Full Name | Janice Martin Licensed Clinical Social Worker Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 710 Main St, Port Jefferson, New York |
| Authorized Official Name and Position | Janice M Martin (PRESIDENT) |
| Authorized Official Contact | 6316807222 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Janice Martin Licensed Clinical Social Worker Pc Po Box 433 Port Jefferson NY 11777-0433 Ph: (631) 680-7222 | Janice Martin Licensed Clinical Social Worker Pc 710 Main St Port Jefferson NY 11777-2278 Ph: (631) 680-7222 |
| NPI Number | 1902427941 |
|---|---|
| Provider Enumeration Date | 04/30/2020 |
| Last Update Date | 04/30/2020 |
| Certification Date | 04/30/2020 |
| Medicare PECOS PAC ID | 6305252537 |
|---|---|
| Medicare Enrollment ID | O20210312000178 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902427941 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Janice M Martin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336205350 PECOS PAC ID: 5597809921 Enrollment ID: I20100223000240 |
| Provider Name | Jill D Buckley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427366384 PECOS PAC ID: 9436323953 Enrollment ID: I20111119000034 |
| Provider Name | Katherine A Marro |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558726349 PECOS PAC ID: 2062749252 Enrollment ID: I20190812000192 |
| Provider Name | Amanda Mazzone |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497133979 PECOS PAC ID: 3971934332 Enrollment ID: I20200519001934 |
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