Healthcare Provider Details

I. General information

NPI: 1699695155
Provider Name (Legal Business Name): TIAHANA MARIE MARTINEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 E 30TH ST
ERIE PA
16504-1262
US

IV. Provider business mailing address

824 E 30TH ST
ERIE PA
16504-1262
US

V. Phone/Fax

Practice location:
  • Phone: 814-923-2543
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW027669
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: