Provider Demographics
NPI:1710181706
Name:EMERICK, MARTHA LAVAN (MS, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:LAVAN
Last Name:EMERICK
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 PINE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:PA
Mailing Address - Zip Code:15538-2318
Mailing Address - Country:US
Mailing Address - Phone:814-267-5143
Mailing Address - Fax:
Practice Address - Street 1:419 STOYSTOWN RD
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-6945
Practice Address - Country:US
Practice Address - Phone:814-443-3797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003570101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032808310002Medicaid
PA101882230Medicaid