Provider Demographics
NPI:1740679729
Name:MARTIN, BRENDA (BSW)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E FLORENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-4666
Mailing Address - Country:US
Mailing Address - Phone:520-836-4278
Mailing Address - Fax:520-836-1786
Practice Address - Street 1:900 E FLORENCE BLVD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4666
Practice Address - Country:US
Practice Address - Phone:520-836-4278
Practice Address - Fax:520-836-1786
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health