Individual
JOHNNY MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LISW
Contact information
Practice address
1900 10TH ST, ALAMOGORDO, NM 88310-5053
(505) 437-7404
(505) 439-2860
Mailing address
1900 10TH ST, ALAMOGORDO, NM 88310-5053
(505) 437-7404
(505) 439-2860
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I-3203
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000H5737
—
NM
Enumeration date
08/09/2006
Last updated
07/08/2007
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