Provider Demographics
NPI:1386232478
Name:MARTIN, REESHA-ANN MELODY
Entity type:Individual
Prefix:
First Name:REESHA-ANN
Middle Name:MELODY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 BAYARD RD
Mailing Address - Street 2:
Mailing Address - City:LOTHIAN
Mailing Address - State:MD
Mailing Address - Zip Code:20711-9609
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2335 RAYNOLDS PL SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-3246
Practice Address - Country:US
Practice Address - Phone:973-955-6967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool