| Russell Anthony Martin Psychotherapy Lcsw Pc | |
|
11 Broadway Ste 1158 New York NY 10004-1597 | |
| (646) 251-7869 | |
| Not Available |
| Full Name | Russell Anthony Martin Psychotherapy Lcsw Pc |
|---|---|
| Speciality | Social Worker |
| Location | 11 Broadway Ste 1158, New York, New York |
| Authorized Official Name and Position | Russell Anthony Martin (PSYCHOTHERAPIST) |
| Authorized Official Contact | 6462517869 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Russell Anthony Martin Psychotherapy Lcsw Pc 29 Mountain Trl Croton On Hudson NY 10520-2209 Ph: (646) 251-7869 | Russell Anthony Martin Psychotherapy Lcsw Pc 11 Broadway Ste 1158 New York NY 10004-1597 Ph: (646) 251-7869 |
| NPI Number | 1841943909 |
|---|---|
| Provider Enumeration Date | 01/30/2022 |
| Last Update Date | 02/18/2022 |
| Certification Date | 02/18/2022 |
| Medicare PECOS PAC ID | 5395137236 |
|---|---|
| Medicare Enrollment ID | O20220126001848 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841943909 | NPI | - | NPPES |
| 1588055313 | Other | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Russell A Martin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588055313 PECOS PAC ID: 6608127501 Enrollment ID: I20180914001788 |
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