Lisa R Martin, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW2979 Issued in FL

Practice address

1370 Patrick Dr
Patrick AFB, FL 32925-3606

Phone

(321) 494-8234

Fax

(321) 494-8074

NPI assigned

Jan 24, 2007

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

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": "1169596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1417002197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 INDIAN CREEK DR",
            "city": "COCOA BEACH",
            "state": "FL",
            "postal_code": "329312833",
            "telephone_number": "321-784-3532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1370 PATRICK DR",
            "city": "PATRICK AFB",
            "state": "FL",
            "postal_code": "329253606",
            "telephone_number": "321-494-8234",
            "fax_number": "321-494-8074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "LISA",
        "middle_name": "R",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-24",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW2979",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Justin L Jennings, DMD
• Ian James Johnson, M.D.
• Sondra Adele Long, LCSW
• Rhonda Mangione, PHARMACIST
• Naquita Jackson Manning, NP
• Gabriela Martinez, MD
• Kevin S McCaughin, PHARMD
• Kyle McIntosh, D.O.
• Lakisha C Miller, ARNP
• Lashawnda Mobley, PHARMD

• Clinical Social Worker in Patrick AFB, FL
• Providers in Patrick AFB, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.