Provider Demographics
NPI:1780963504
Name:MARTINEZ, PEGGY A (LCSW)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:A
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 LOOP 306
Mailing Address - Street 2:STE 110
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-5983
Mailing Address - Country:US
Mailing Address - Phone:325-942-1952
Mailing Address - Fax:
Practice Address - Street 1:3115 LOOP 306
Practice Address - Street 2:STE 110
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-5983
Practice Address - Country:US
Practice Address - Phone:325-942-1952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical