Provider Demographics
NPI:1730623844
Name:MARTINO, JENNIFER R (LSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:MARTINO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-3204
Mailing Address - Country:US
Mailing Address - Phone:216-931-1400
Mailing Address - Fax:
Practice Address - Street 1:2500 E 22ND ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3204
Practice Address - Country:US
Practice Address - Phone:216-931-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1502353104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2098359Medicaid
OH1972553063OtherBUSINESS NPI
OH1972553063OtherBUSINESS NPI