Provider Demographics
NPI:1891382081
Name:MARTIN, ANGELINA ROSE (MSW)
Entity Type:Individual
Prefix:
First Name:ANGELINA
Middle Name:ROSE
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 1:1130 CHARNELTON ALY
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3480
Mailing Address - Country:US
Mailing Address - Phone:503-812-7763
Mailing Address - Fax:
Practice Address - Street 1:1130 CHARNELTON ALY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3480
Practice Address - Country:US
Practice Address - Phone:503-812-7763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor