Individual provider Active NPI

Justin Martin, LCSW

  • Clinical Social Worker
  • Las Vegas, NV
National Provider Identifier
1265930655
Registry record updated Aug 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW-20365 Issued in AZ
Practice address
2121 W Charleston Blvd
Las Vegas, NV 89102-2205
Phone
(702) 727-4360
NPI assigned
Jan 31, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 8446-C NV
Clinical Social Worker 1041C0700X I.1901465 OH
Clinical Social Worker 1041C0700X LCSW-20365 AZ Primary

Addresses

Primary practice location

2121 W Charleston Blvd
Las Vegas, NV 89102-2205

Mailing address

2121 W Charleston Blvd
Las Vegas, NV 89102-2205

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200908003423 NV Practitioner - Clinical Social Worker 9537587597 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCSW-20365AZMDClinical Social Worker
8446-CNVMDClinical Social Worker
I.1901465OHMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Charleston Residential Services LLC CurrentSince Jul 1, 2021 Accepting new patients
Next Level Psychiatry Arizona PLLC CurrentSince Aug 1, 2020 Accepting new patients
Behavioral Health Solutions LLC Clinical CurrentSince Aug 1, 2020 Accepting new patients

Locations

2200 Paseo Verde Pkwy
Ste 190
Henderson, NV 89052
Phone (702) 483-5061

1120 Shadow Ln
Las Vegas, NV 89102
Phone (702) 499-2239

2121 W Charleston Blvd
Las Vegas, NV 89102
Phone (702) 382-7746

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1517356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692662400000",
    "number": "1265930655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 W CHARLESTON BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891022205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 W CHARLESTON BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891022205",
            "telephone_number": "702-727-4360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "JUSTIN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-01-31",
        "last_updated": "2023-08-22",
        "certification_date": "2023-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NV",
            "license": "8446-C",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.1901465",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AZ",
            "license": "LCSW-20365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.