MEDICARE: VINITA MARTIN RSW

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	171M00000X	Case Manager/Care Coordinator
2	104100000X	Social Worker	7760	LA

General Provider Information

NPI Number	:	1669829222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINITA MARTIN RSW

Provider Business Mailing Address
First Line	:	6641 GOVERNMENT ST
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-6245
Country	:	US
Telephone Number	:	225-926-9706
Fax Number	:	225-926-9708

Provider Business Practice Location Address
First Line	:	6641 GOVERNMENT STREET
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806
Country	:	US
Telephone Number	:	225-926-9706
Fax Number	:	225-926-9708

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

Provider Enumeration Date	:	05/24/2016
Last Update Date	:	09/19/2018

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