Provider Demographics
NPI:1730196361
Name:MARTINI, EILEEN (MS, LCPC)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:
Last Name:MARTINI
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2807 DEEPWATER TRL
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-1218
Mailing Address - Country:US
Mailing Address - Phone:410-573-0910
Mailing Address - Fax:
Practice Address - Street 1:275 WEST ST STE 100A
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3468
Practice Address - Country:US
Practice Address - Phone:410-703-7450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2013-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1242101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health