Provider Demographics
NPI:1962925586
Name:RAGSDALE, MARTHA VANESSA (LCSW)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:VANESSA
Last Name:RAGSDALE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:M.
Other - Middle Name:VANESSA
Other - Last Name:RAGSDALE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:2050A 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:KIRTLAND AFB
Mailing Address - State:NM
Mailing Address - Zip Code:87117-5901
Mailing Address - Country:US
Mailing Address - Phone:505-846-3200
Mailing Address - Fax:
Practice Address - Street 1:2050A 2ND ST SE
Practice Address - Street 2:
Practice Address - City:KIRTLAND AFB
Practice Address - State:NM
Practice Address - Zip Code:87117-1694
Practice Address - Country:US
Practice Address - Phone:505-846-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-25
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0022601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical