Provider Demographics
NPI:1114232840
Name:MARTIN, JUANA R (MSW)
Entity Type:Individual
Prefix:MS
First Name:JUANA
Middle Name:R
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2218 PRIMROSE DR
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-1838
Mailing Address - Country:US
Mailing Address - Phone:571-338-3827
Mailing Address - Fax:
Practice Address - Street 1:2218 PRIMROSE DR
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-1838
Practice Address - Country:US
Practice Address - Phone:571-338-3827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040066421041C0700X
MD122041041C0700X
DCLC30008151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical