MEDICARE: DENIELLE MARTIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1407278633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENIELLE MARTIN

Provider Business Mailing Address
First Line	:	14555 PHILIPPINE ST APT 827
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77040-7818
Country	:	US
Telephone Number	:	972-693-5314
Fax Number	:

Provider Business Practice Location Address
First Line	:	9705 RAILROAD
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-7413
Country	:	US
Telephone Number	:	972-693-5314
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2014
Last Update Date	:	09/11/2025

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Directions to “ DENIELLE MARTIN ” Practice Location

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