Active NPI
Mary Martin, MSW
- Clinical Social Worker
- Tupelo, MS
National Provider Identifier
1154743441
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- C-6986
- Practice address
- 2434 S Eason Blvd
Tupelo, MS 38804-6942 - Phone
- (662) 640-4595
- Fax
- (662) 680-6416
- NPI assigned
- Jan 6, 2014
- Last updated
- Sep 4, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | M6986 | MS | |
| Mental Health Counselor | 101YM0800X | |||
| Clinical Social Worker | 1041C0700X | C-6986 | MS | Primary |
Addresses
Primary practice location
2434 S Eason Blvd
Tupelo, MS 38804-6942
Mailing address
2434 S Eason Blvd
Tupelo, MS 38804-6942
Phone (662) 640-4595
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
777 Holly Hill Dr
Tupelo, MS 38801-2340
Phone (662) 432-1221
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M6986 | MS | MD | Social Worker |
| C-6986 | MS | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| RH Arise Venture of Tupelo LLC | Current | Accepting new patients |
Locations
777 Holly Hill Dr
Tupelo, MS 38801
Phone (662) 432-1221
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Psychiatry Physician
- Tupelo, MS
- NPI 1124776067
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1388966400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1756944000000",
"number": "1154743441",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2434 S EASON BLVD",
"city": "TUPELO",
"state": "MS",
"postal_code": "388046942",
"telephone_number": "662-640-4595",
"fax_number": "662-680-6416"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2434 S EASON BLVD",
"city": "TUPELO",
"state": "MS",
"postal_code": "388046942",
"telephone_number": "662-640-4595",
"fax_number": "662-680-6416"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "MARY",
"name_prefix": "Mrs.",
"credential": "MSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-01-06",
"last_updated": "2025-09-04",
"certification_date": "2025-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MS",
"license": "M6986",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MS",
"license": "C-6986",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Tupelo, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.