Provider Demographics
NPI:1376609438
Name:HARDIN-MONIZ, MARTHA RACHELLE (LCSW, ACSW)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:RACHELLE
Last Name:HARDIN-MONIZ
Suffix:
Gender:F
Credentials:LCSW, ACSW
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 5423
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-5423
Mailing Address - Country:US
Mailing Address - Phone:405-366-6068
Mailing Address - Fax:405-366-6281
Practice Address - Street 1:2420 SPRINGER DR
Practice Address - Street 2:SUITE 215
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-3965
Practice Address - Country:US
Practice Address - Phone:405-366-6068
Practice Address - Fax:405-366-6281
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK900522257Medicare ID - Type UnspecifiedPROVIDER