Healthcare Provider Details

I. General information

NPI: 1093236028
Provider Name (Legal Business Name): YVETTE S MARTIN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 POYDRAS ST STE A
NEW ORLEANS LA
70119-7561
US

IV. Provider business mailing address

1000 CHINABERRY DR STE 900
BOSSIER CITY LA
71111-2455
US

V. Phone/Fax

Practice location:
  • Phone: 504-814-8001
  • Fax:
Mailing address:
  • Phone: 318-742-3408
  • Fax: 318-841-1210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number5218
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number5218
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: