MEDICARE: MRS. MARTA ELENA REASONER LCSW

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	S11131	TX

General Provider Information

NPI Number	:	1770500449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARTA ELENA REASONER LCSW

Provider Business Mailing Address
First Line	:	2001 W NATHAN LOWE RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-4443
Country	:	US
Telephone Number	:	817-465-0312
Fax Number	:

Provider Business Practice Location Address
First Line	:	3840 HULEN ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-7277
Country	:	US
Telephone Number	:	817-335-3022
Fax Number	:

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	02/28/2019

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