Provider Demographics
NPI:1366203242
Name:MARTINEK, ELOISE ALEXANDRA (LCSW)
Entity type:Individual
Prefix:
First Name:ELOISE
Middle Name:ALEXANDRA
Last Name:MARTINEK
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 1:1419 OAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-7759
Mailing Address - Country:US
Mailing Address - Phone:479-409-4471
Mailing Address - Fax:
Practice Address - Street 1:9321 MIDLOTHIAN TPKE STE C
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4941
Practice Address - Country:US
Practice Address - Phone:804-252-4525
Practice Address - Fax:804-597-0213
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040162651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical