Provider Demographics
NPI:1871055343
Name:MARTIN, KIMBERLY P (LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:P
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 MADISON AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-2113
Mailing Address - Country:US
Mailing Address - Phone:443-468-7116
Mailing Address - Fax:
Practice Address - Street 1:940 MADISON AVE STE 202
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-2113
Practice Address - Country:US
Practice Address - Phone:443-468-7116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD206341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1912478900Medicaid