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General NPI Number Information
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NPI Number | 1114232840
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Entity Type | Individual
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Provider Name | JUANA R. MARTIN M.S.W.
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Gender | Female
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Dates
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Enumeration Date | 08/18/2010
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Last Update Date | 08/18/2010
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Provider Practice Location Address
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Address Line | 2218 PRIMROSE DR
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City | FALLS CHURCH
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State | VA
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Zip | 22046-1838
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Country | US
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Telephone | 571-338-3827
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Fax |
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Provider Business Mailing Address
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Address Line | 2218 PRIMROSE DR
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City | FALLS CHURCH
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State | VA
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Zip | 22046-1838
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Country | US
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Telephone | 571-338-3827
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904006642
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 12204
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC3000815
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License Number State | DC
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