Provider Demographics
NPI:1821278623
Name:SCRANTON, MARTHA LAROSA (LCSW)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:LAROSA
Last Name:SCRANTON
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 1:2717 N STEVES BLVD
Mailing Address - Street 2:# 11
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-3959
Mailing Address - Country:US
Mailing Address - Phone:928-526-2968
Mailing Address - Fax:928-526-0708
Practice Address - Street 1:2717 N STEVES BLVD
Practice Address - Street 2:# 11
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-3959
Practice Address - Country:US
Practice Address - Phone:928-526-2968
Practice Address - Fax:928-526-0708
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-10195101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLCSW 718 174Medicaid