Provider Demographics
NPI:1669829222
Name:MARTIN, VINITA (RSW)
Entity Type:Individual
Prefix:
First Name:VINITA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6641 GOVERNMENT ST
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-6245
Mailing Address - Country:US
Mailing Address - Phone:225-926-9706
Mailing Address - Fax:225-926-9708
Practice Address - Street 1:6641 GOVERNMENT STREET
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806
Practice Address - Country:US
Practice Address - Phone:225-926-9706
Practice Address - Fax:225-926-9708
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
LA7760104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator