Individual ProviderNiccol Marie MartinSocial WorkerBehavioral Health & Social Service ProvidersPractice Address5000 W National Ave, Milwaukee, WI 53295-0001(414) 384-2000PECOS EnrollmentBased on the most recent information from CMS, provider Niccol Marie Martin does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 11:47 AM.Profile DetailsProvider ID1740485820Provider TypeIndividualFull NameMartin, Niccol MarieCredentialMSW, LCSWGenderFemaleSole ProprietorYesEnumeration Date6/18/2007Last Updated12/13/2010Contact InformationPractice LocationPractice Address5000 W National Ave, Milwaukee, WI 53295-0001Phone(414) 384-2000FaxUnlisted FaxMailing LocationMailing Address5000 W National Ave, Milwaukee, WI 53295-0001Phone(414) 384-2000FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense7623-123WisconsinCode104100000XDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense127247-121Wisconsin