Provider Demographics
NPI:1144438334
Name:MARTIN, ROSEMARY MILLER (MSW)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:MILLER
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 WILLOW ST STE 500A
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3254
Mailing Address - Country:US
Mailing Address - Phone:612-377-9866
Mailing Address - Fax:
Practice Address - Street 1:1409 WILLOW ST STE 500A
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3254
Practice Address - Country:US
Practice Address - Phone:612-377-9866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN15581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5G407MAOtherBLUE CROSS