Provider Demographics
NPI:1043033319
Name:MARTINEZ CHAVIRA, JANNET (LSW)
Entity type:Individual
Prefix:
First Name:JANNET
Middle Name:
Last Name:MARTINEZ CHAVIRA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 PASEO PL
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-3264
Mailing Address - Country:US
Mailing Address - Phone:719-691-8791
Mailing Address - Fax:
Practice Address - Street 1:9201 W 44TH AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-3084
Practice Address - Country:US
Practice Address - Phone:720-551-4269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0009925790104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker