Provider Demographics
NPI:1447353974
Name:BARKER, MARTHA J (RN LCSW)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:J
Last Name:BARKER
Suffix:
Gender:F
Credentials:RN LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16019 VIA SHAVANO
Mailing Address - Street 2:SHAVANO COMMONS
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249
Mailing Address - Country:US
Mailing Address - Phone:210-393-4598
Mailing Address - Fax:210-690-8815
Practice Address - Street 1:16019 VIA SHAVANO
Practice Address - Street 2:SHAVANO COMMONS
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249
Practice Address - Country:US
Practice Address - Phone:210-393-4598
Practice Address - Fax:210-690-8815
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20688104100000X
TX218483163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX119764203Medicaid
TXOOS91UMedicare UPIN