Provider Demographics
NPI:1609203074
Name:MARTIN, ELIZABETH ANNE (LMHC-P)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMHC-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 US OVAL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12903-5900
Mailing Address - Country:US
Mailing Address - Phone:518-561-1767
Mailing Address - Fax:
Practice Address - Street 1:22 US OVAL
Practice Address - Street 2:SUITE 100
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12903-5900
Practice Address - Country:US
Practice Address - Phone:518-561-1767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP90779101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health