Keith Martin

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

R036920-1 Issued in NY

Practice address

56 Bay St
Staten Island, NY 10301-2563

Phone

(718) 808-1420

Fax

(718) 808-1390

NPI assigned

Dec 22, 2010

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1292976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1013211663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "56 BAY ST",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103012563",
            "telephone_number": "718-808-1420",
            "fax_number": "718-808-1390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56 BAY ST",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103012563",
            "telephone_number": "718-808-1420",
            "fax_number": "718-808-1390"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1720 S Gadsden St",
            "address_purpose": "LOCATION",
            "city": "Tallahassee",
            "state": "FL",
            "postal_code": "323015506",
            "country_code": "US",
            "telephone_number": "850-576-4073 x218",
            "fax_number": "850-576-8259",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "KEITH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-12-22",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "PSW800",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R036920-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Catherine Martin, LMSW
• Colleen Martin, PHARMD
• Hartman Myguy Martin, MD
• Jennifer Rose Martin, RN
• Karen Martin, CRPA
• Kisha Ann Martin
• Marian L Martin, NP
• Michelle Martin, RN
• Sharlene Martin, CASAC-T
• Sulmarien Martinez Grullon

• Clinical Social Worker in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.