Mark Martin, CDCA.166404

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CDCA.166404 Issued in OH

Practice address

11811 Shaker Blvd Ste 123
Cleveland, OH 44120-1927

Phone

(216) 965-6325

NPI assigned

Jun 17, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1529193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529193600000",
    "number": "1164916805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "828 ARBORETUM CIR",
            "city": "NORTHFIELD",
            "state": "OH",
            "postal_code": "440672340",
            "telephone_number": "330-348-7808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11811 SHAKER BLVD STE 123",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441201927",
            "telephone_number": "216-965-6325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "MARK",
        "credential": "CDCA.166404",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-06-17",
        "last_updated": "2018-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "CDCA.166404",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CDCA.166404",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Linda Martin
• Lorenzo Russell Martin
• Louis Charles Martin III
• Lynn Nicole Martin
• Makenna Martin, GC
• Marquetta Martin, CERTIFIED DOULA
• Maurice Martin
• Michelle Martin, ED.S.
• Michelle L Martin, RD
• Molly Martin, LISW-S

• Addiction (Substance Use Disorder) Counselor in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2018; 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.