Provider Demographics
NPI:1881132637
Name:MARTIN, ROXANNA (BSW)
Entity type:Individual
Prefix:
First Name:ROXANNA
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 1:5418 EADS ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122
Mailing Address - Country:US
Mailing Address - Phone:504-330-5329
Mailing Address - Fax:
Practice Address - Street 1:5418 EADS ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122
Practice Address - Country:US
Practice Address - Phone:504-330-5329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
LA008296044171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator