Provider Demographics
NPI:1891037107
Name:EVANS, MARTINEK TUEBIA (MSW)
Entity type:Individual
Prefix:
First Name:MARTINEK
Middle Name:TUEBIA
Last Name:EVANS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:MARTINEK
Other - Middle Name:T
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:1000 MON HEALTH MEDICAL PARK DR STE 1202
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1143
Mailing Address - Country:US
Mailing Address - Phone:304-599-1975
Mailing Address - Fax:304-599-2705
Practice Address - Street 1:1000 MON HEALTH MEDICAL PARK DR STE 1202
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505
Practice Address - Country:US
Practice Address - Phone:304-599-1975
Practice Address - Fax:304-599-2705
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00943157104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker