Healthcare Provider Details

I. General information

NPI: 1902955438
Provider Name (Legal Business Name): BARBARA JEAN MARTIN LBSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 RIDGE RD SUITE 205
ROCKWALL TX
75087-2569
US

IV. Provider business mailing address

14900 LASATER RD LOT 323
DALLAS TX
75253-7623
US

V. Phone/Fax

Practice location:
  • Phone: 972-768-9230
  • Fax: 972-722-4087
Mailing address:
  • Phone: 469-644-7733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number18975
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: