| Mary M Martineau Lcsw Llc | |
|
1355 S 1100 E Salt Lake City UT 84105 | |
| (801) 425-4187 | |
| Not Available |
| Full Name | Mary M Martineau Lcsw Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1355 S 1100 E, Salt Lake City, Utah |
| Authorized Official Name and Position | Mary M Martineau (SOLE OWNER) |
| Authorized Official Contact | 8014254187 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary M Martineau Lcsw Llc 1355 S 1100 E Salt Lake City UT 84105-2432 Ph: (801) 425-4187 | Mary M Martineau Lcsw Llc 1355 S 1100 E Salt Lake City UT 84105 Ph: (801) 425-4187 |
| NPI Number | 1770039109 |
|---|---|
| Provider Enumeration Date | 08/26/2016 |
| Last Update Date | 08/26/2016 |
| Medicare PECOS PAC ID | 5092003954 |
|---|---|
| Medicare Enrollment ID | O20161007001385 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770039109 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 8394257-3501 (Utah) | Primary |
| Provider Name | Mary M Martineau |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124404504 PECOS PAC ID: 4284940768 Enrollment ID: I20150828000606 |
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