Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 60231535 | WA |
NPI | 1003212770 |
---|---|
Provider Name | Erin Martinache |
First Address | Shelton, WA 98584-7126 |
Second Address | Shelton, WA 98584-7126 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2014 |
Last Update Date | 17/03/2021 |