Basic Information
| Provider Information | |||||||||
| NPI: | 1316307028 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6574 FLEUR DE LIS DR APT 20 | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701241492 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5042109958 | ||||||||
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| Practice Location | |||||||||
| Address1: | 330 N JEFFERSON DAVIS PKWY | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701195312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5049486880 | ||||||||
| FaxNumber: | 5042784007 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2016 | ||||||||
| LastUpdateDate: | 05/13/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | N | Other Service Providers | Community Health Worker | 101YM0800X | LA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.