Active NPI
Keith Martin
- Mental Health Counselor
- Morrisonville, NY
National Provider Identifier
1760145668
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 017636
- Practice address
- 2155 Route 22B
Morrisonville, NY 12962-3417 - Phone
- (518) 563-8000
- Fax
- (518) 324-2178
- NPI assigned
- Oct 18, 2021
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 41497 | NY | |
| Mental Health Counselor | 101YM0800X | 017636 | NY | Primary |
Addresses
Primary practice location
2155 Route 22B
Morrisonville, NY 12962-3417
Mailing address
416 Stafford Rd
Plattsburgh, NY 12901-6121
Phone (518) 593-7853
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2155 State Route 22B
Morrisonville, NY 12962-3417
Phone (518) 563-8000
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 41497 | NY | MD | Addiction (Substance Use Disorder) Counselor |
| 017636 | NY | MD | Speech-Language Pathologist |
Organizations & group practices 1
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Morrisonville, NY
- NPI 1689621468
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1634515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1773187200000",
"number": "1760145668",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "416 STAFFORD RD",
"city": "PLATTSBURGH",
"state": "NY",
"postal_code": "129016121",
"telephone_number": "518-593-7853"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2155 ROUTE 22B",
"city": "MORRISONVILLE",
"state": "NY",
"postal_code": "129623417",
"telephone_number": "518-563-8000",
"fax_number": "518-324-2178"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "KEITH",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-10-18",
"last_updated": "2026-03-11",
"certification_date": "2026-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NY",
"license": "41497",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NY",
"license": "017636",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Morrisonville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.