Provider Demographics
NPI:1053464990
Name:DEMPSTER, MARTHA (LICSW)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:
Last Name:DEMPSTER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 TEN ROD RD
Mailing Address - Street 2:D104
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-4180
Mailing Address - Country:US
Mailing Address - Phone:401-935-9784
Mailing Address - Fax:401-295-5552
Practice Address - Street 1:1130 TEN ROD RD
Practice Address - Street 2:D104
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-4180
Practice Address - Country:US
Practice Address - Phone:401-935-9784
Practice Address - Fax:401-295-5552
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW015371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI409249OtherBLUE CHIP
RI1037150OtherNEIGHBORHOOD HEALTH PLAN
RI301257OtherBLUE CROSS BLUE SHIELD