Provider Demographics
NPI:1487419354
Name:MARTIN, HEATHER K (JD, LSW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:K
Last Name:MARTIN
Suffix:
Gender:F
Credentials:JD, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 VIOLET CT
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-1316
Mailing Address - Country:US
Mailing Address - Phone:732-567-7509
Mailing Address - Fax:
Practice Address - Street 1:34 SYCAMORE AVE STE 2E
Practice Address - Street 2:
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1248
Practice Address - Country:US
Practice Address - Phone:732-503-9047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL070761001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical