Basic Information
| Provider Information | |||||||||
| NPI: | 1093844029 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | MARGARET | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2501 W WILLIAM CANNON DR | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787455253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124167246 | ||||||||
| FaxNumber: | 5124166791 | ||||||||
| Practice Location | |||||||||
| Address1: | 2501 W WILLIAM CANNON DR | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787455253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124167246 | ||||||||
| FaxNumber: | 5124166791 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 12/14/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 34223 | TX | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 192378101 | 05 | TX | MEDICAID |