Healthcare Provider Details

I. General information

NPI: 1275879108
Provider Name (Legal Business Name): MARTHA STANOJEVICH MSSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2012
Last Update Date: 01/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 CHILHOWEE MEDICAL PARK
MARYVILLE TN
37804-5285
US

IV. Provider business mailing address

PO BOX 5209
MARYVILLE TN
37802-5209
US

V. Phone/Fax

Practice location:
  • Phone: 865-982-3400
  • Fax: 865-238-2034
Mailing address:
  • Phone: 865-236-1503
  • Fax: 865-238-2034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6091
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6088
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: