Active NPI
Andrew Wood Martin, LCSW-R
- Clinical Social Worker
- Kingston, NY
National Provider Identifier
1497824635
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- R057402-1
- Practice address
- 239 Golden Hill LN
Kingston, NY 12401-6441 - Phone
- (845) 340-4000
- Fax
- (845) 340-4070
- NPI assigned
- Nov 6, 2006
- Sex
- Male
- 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 | R057402-1 | NY | Primary |
Addresses
Primary practice location
239 Golden Hill LN
Kingston, NY 12401-6441
Mailing address
64 Cutler Hill Rd
Eddyville, NY 12401-8718
Phone (845) 338-0911
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| R0574021 | Other | NY | LCSW-R |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R057402-1 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1497824635",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "64 CUTLER HILL RD",
"city": "EDDYVILLE",
"state": "NY",
"postal_code": "124018718",
"telephone_number": "845-338-0911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "239 GOLDEN HILL LN",
"city": "KINGSTON",
"state": "NY",
"postal_code": "124016441",
"telephone_number": "845-340-4000",
"fax_number": "845-340-4070"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "ANDREW",
"middle_name": "WOOD",
"name_prefix": "Mr.",
"credential": "LCSW-R",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "R057402-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LCSW-R",
"identifier": "R0574021",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kingston, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.