Provider Demographics
NPI:1518203660
Name:MARTIN, ANDREA H (LCSW)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:H
Last Name:MARTIN
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 1:1510 CHEMIN AGREABLE RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-6202
Mailing Address - Country:US
Mailing Address - Phone:337-345-1305
Mailing Address - Fax:337-201-9315
Practice Address - Street 1:221 RUE DE JEAN STE 126A
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-8501
Practice Address - Country:US
Practice Address - Phone:337-345-1305
Practice Address - Fax:337-201-9315
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-18
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA59071041C0700X, 101YM0800X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
14103912OtherCAQH
LA5907OtherSTATE LCSW LICENSE