MEDICARE: RICKI BRIANA MARTIN 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	374J00000X	Doula
2	1041C0700X	Clinical Social Worker	10377	TN

General Provider Information

NPI Number	:	1922717065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICKI BRIANA MARTIN LCSW

Provider Business Mailing Address
First Line	:	1910 MADISON AVE # 2358
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38104-2620
Country	:	US
Telephone Number	:	901-414-8708
Fax Number	:

Provider Business Practice Location Address
First Line	:	7158 MILLERS GLEN WAY
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38125-4170
Country	:	US
Telephone Number	:	901-413-8420
Fax Number	:

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

Provider Enumeration Date	:	11/17/2022
Last Update Date	:	06/29/2026

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