Provider Demographics
NPI:1750523122
Name:DAVIS-MARTINEZ, VIVIAN XIMENA (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:XIMENA
Last Name:DAVIS-MARTINEZ
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 VALENTINE RD
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-2099
Mailing Address - Country:US
Mailing Address - Phone:610-966-3306
Mailing Address - Fax:
Practice Address - Street 1:2341 WALBERT AVE
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-1351
Practice Address - Country:US
Practice Address - Phone:610-434-2431
Practice Address - Fax:610-434-8384
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0161971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical