Provider Demographics
NPI:1023033602
Name:MARTYN, SHARON M (LCSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:M
Last Name:MARTYN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6744
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70174
Mailing Address - Country:US
Mailing Address - Phone:504-309-7844
Mailing Address - Fax:504-309-7845
Practice Address - Street 1:401 WHITNEY AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-2558
Practice Address - Country:US
Practice Address - Phone:504-309-7844
Practice Address - Fax:504-309-7845
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALCSW 2405104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1650455Medicaid