Active NPI
Mark Allen Martello, LCSW
- Clinical Social Worker
- Iron Mountain, MI
National Provider Identifier
1629068622
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW-1205
- Practice address
- 325 E H St
Iron Mountain, MI 49801-4760 - Phone
- (906) 774-3300
- NPI assigned
- Oct 21, 2005
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 8830-123 | WI | |
| Clinical Social Worker | 1041C0700X | LCSW-1205 | ID | Primary |
Addresses
Primary practice location
325 E H St
Iron Mountain, MI 49801-4760
Mailing address
N10994 Spring Creek Dr
Tomahawk, WI 54487-9718
Phone (808) 754-5504
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LCSW-1205 | Other | ID | STATE LICENSE |
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 |
|---|---|---|---|
| LCSW-1205 | ID | MD | Clinical Social Worker |
| 8830-123 | WI | MD | Clinical Social Worker |
| 8830 | WI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568073600000",
"number": "1629068622",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "N10994 SPRING CREEK DR",
"city": "TOMAHAWK",
"state": "WI",
"postal_code": "544879718",
"telephone_number": "808-754-5504"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "325 E H ST",
"city": "IRON MOUNTAIN",
"state": "MI",
"postal_code": "498014760",
"telephone_number": "906-774-3300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTELLO",
"first_name": "MARK",
"middle_name": "ALLEN",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-21",
"last_updated": "2019-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WI",
"license": "8830-123",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "ID",
"license": "LCSW-1205",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "LCSW-1205",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Iron Mountain, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.