Organization
MARY M MARTINEAU LCSW LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY M MARTINEAU LCSW (SOLE OWNER)
(801) 425-4187
Entity
Organization
Contact information
Practice address
1355 S 1100 E, SALT LAKE CITY, UT 84105
(801) 425-4187
Mailing address
1355 S 1100 E, SALT LAKE CITY, UT 84105-2432
(801) 425-4187
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
8394257-3501
UT
Other
Enumeration date
08/26/2016
Last updated
08/26/2016
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