Provider Demographics
NPI:1497454698
Name:MARTIN, KARL WILLIAM (RBT)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:WILLIAM
Last Name:MARTIN
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 UTICA DR
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01603-1622
Mailing Address - Country:US
Mailing Address - Phone:617-855-1954
Mailing Address - Fax:
Practice Address - Street 1:85 WILBRAHAM RD
Practice Address - Street 2:
Practice Address - City:HAMPDEN
Practice Address - State:MA
Practice Address - Zip Code:01036-9705
Practice Address - Country:US
Practice Address - Phone:413-419-5743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MABACB812410106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician