Organization
ANGELA MARTIN PSYCHOTHERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANGELA MARTIN LCSW (PRESIDENT)
(262) 515-3220
Entity
Organization
Contact information
Practice address
6021 DURAND AVE, RACINE, WI 53406-5096
(262) 554-0126
Mailing address
5930 5TH AVE, KENOSHA, WI 53140-4214
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6568-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39746200
—
WI
Enumeration date
03/21/2007
Last updated
08/22/2020
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