Provider Demographics
NPI:1225704653
Name:MARTINEK, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MARTINEK
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 1:132 WALNUT ST STE 3
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-1621
Mailing Address - Country:US
Mailing Address - Phone:814-535-8830
Mailing Address - Fax:814-536-3233
Practice Address - Street 1:132 WALNUT ST STE 3
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-1621
Practice Address - Country:US
Practice Address - Phone:814-535-8830
Practice Address - Fax:814-536-3233
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)