Provider Demographics
NPI:1972203610
Name:AREVALO MARTINEZ, TANIA NICOLE (LICSW)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:NICOLE
Last Name:AREVALO MARTINEZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:TANIA
Other - Middle Name:NICOLE
Other - Last Name:LITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14217 LUSBY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ACCOKEEK
Mailing Address - State:MD
Mailing Address - Zip Code:20607-3762
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14217 LUSBY RIDGE RD
Practice Address - Street 2:
Practice Address - City:ACCOKEEK
Practice Address - State:MD
Practice Address - Zip Code:20607-3762
Practice Address - Country:US
Practice Address - Phone:240-441-4034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC2000013381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical