Provider Demographics
NPI:1003227190
Name:MARTHA L. SCRANTON, MS.LCSW
Entity Type:Organization
Organization Name:MARTHA L. SCRANTON, MS.LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIANE
Authorized Official - Middle Name:V
Authorized Official - Last Name:ALVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-214-1070
Mailing Address - Street 1:PO BOX 30310
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86003-0310
Mailing Address - Country:US
Mailing Address - Phone:928-214-1070
Mailing Address - Fax:928-214-1071
Practice Address - Street 1:711 N BEAVER ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3103
Practice Address - Country:US
Practice Address - Phone:928-214-1070
Practice Address - Fax:928-214-1071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1821278623Medicaid
AZZ149442Medicare PIN