Provider Demographics
NPI:1760888796
Name:MARTIN, MAEVE LEE
Entity type:Individual
Prefix:
First Name:MAEVE
Middle Name:LEE
Last Name:MARTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:TRAVIS
Other - Middle Name:LEE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14 MULBERRY RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186
Mailing Address - Country:US
Mailing Address - Phone:401-305-0321
Mailing Address - Fax:401-946-1550
Practice Address - Street 1:14 MULBERRY RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186
Practice Address - Country:US
Practice Address - Phone:401-305-0321
Practice Address - Fax:401-946-1550
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-19
Last Update Date:2025-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.0136501TELE1041C0700X
RI15W026221041C0700X
RICSW015721041C0700X
MALICSW11403331041C0700X
NY1222551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical