Active NPI
Kimberly Susan Martin, LCSW-R
- Clinical Social Worker
- Clifton Park, NY
National Provider Identifier
1003959263
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- R050405
- Practice address
- 1745 Route 9
Suite G
Clifton Park, NY 12065 - Phone
- (518) 598-3192
- Fax
- (888) 495-2213
- NPI assigned
- Feb 15, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | R050405 | NY | Primary |
Addresses
Primary practice location
1745 Route 9
Suite G
Clifton Park, NY 12065
Mailing address
1745 Route 9
Suite G
Clifton Park, NY 12065
Phone (518) 598-3192
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190115002745 | NY | Practitioner - Clinical Social Worker | 7416293261 | Practice locations: Clifton Park, NY |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R050405 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1457913600000",
"number": "1003959263",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1745 ROUTE 9",
"address_2": "SUITE G",
"city": "CLIFTON PARK",
"state": "NY",
"postal_code": "12065",
"telephone_number": "518-598-3192",
"fax_number": "888-495-2213"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1745 ROUTE 9",
"address_2": "SUITE G",
"city": "CLIFTON PARK",
"state": "NY",
"postal_code": "12065",
"telephone_number": "518-598-3192",
"fax_number": "888-495-2213"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "KIMBERLY",
"middle_name": "SUSAN",
"name_prefix": "Ms.",
"credential": "LCSW-R",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-15",
"last_updated": "2016-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "R050405",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clifton Park, NY
- Marotta Health and Wellness Chiropractic PLLC
- Antonio V.R. Marotta, D.C.
- Alex G. Marsal, PH.D.
- Martin Neuropsychology PLLC
- Jessica Lynn Martin, PHD
- Rebecca Martin, PH.D.
- Martins Foods of South Burlington LLC
- Mary E Vanalstyne Nurse Practitioner in Family Health PC
- Kayla Marie Marzello
- Douglas E Mason, DPM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.