Provider Demographics
NPI:1205037397
Name:ACEVEDO, MARTINA JEANNIE (PHD, MSW)
Entity Type:Individual
Prefix:MS
First Name:MARTINA
Middle Name:JEANNIE
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:PHD, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 EAST CENTER AVE.
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6331
Mailing Address - Country:US
Mailing Address - Phone:559-737-4700
Mailing Address - Fax:559-737-4782
Practice Address - Street 1:501 NORTH BRIDGE STREET
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5014
Practice Address - Country:US
Practice Address - Phone:559-734-1939
Practice Address - Fax:559-734-4384
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CA252321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical